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  • Rink, Michael  (9)
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  • 1
    Language: English
    In: The Journal of Urology, April 2017, Vol.197(4), pp.e671-e672
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2017.02.1557 Byline: Malte W. Vetterlein, Philipp Gild, Luis A. Kluth Author Affiliation: Hamburg, Germany Article Note: (footnote) Source of Funding: none
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 2
    Language: English
    In: BJU International, 10/11/2017
    Description: OBJECTIVES: To evaluate the effect of peri-operative blood transfusion (PBT) on recurrence-free survival, overall survival, cancer-specific mortality and other-cause mortality in patients undergoing radical cystectomy (RC), using a contemporary European multicentre cohort.PATIENTS AND METHODS: The Prospective Multicentre Radical Cystectomy Series (PROMETRICS) includes data on 679 patients who underwent RC at 18 European tertiary care centres in 2011. The association between PBT and oncological survival outcomes was assessed using Kaplan-Meier, Cox regression and competing-risks analyses. Imbalances in clinicopathological features between patients receiving PBT vs those not receiving PBT were mitigated using conventional multivariable adjusting as well as inverse probability of treatment weighting (IPTW).RESULTS: Overall, 611 patients had complete information on PBT, and 315 (51.6%) received PBT. The two groups (PBT vs no PBT) differed significantly with respect to most clinicopathological features, including peri-operative blood loss: median (interquartile range [IQR]) 1000 (600-1500) mL vs 500 (400-800) mL (P 〈 0.001). Independent predictors of receipt of PBT in multivariable logistic regression analysis were female gender (odds ratio [OR] 5.05, 95% confidence interval [CI] 2.62-9.71; P 〈 0.001), body mass index (OR 0.91, 95% CI 0.87-0.95; P 〈 0.001), type of urinary diversion (OR 0.38, 95% CI 0.18-0.82; P = 0.013), blood loss (OR 1.32, 95% CI 1.23-1.40; P 〈 0.001), neoadjuvant chemotherapy (OR 2.62, 95% CI 1.37-5.00; P = 0.004), and ≥pT3 tumours (OR 1.59, 95% CI 1.02-2.48; P = 0.041). In 531 patients with complete data on survival outcomes, unweighted and unadjusted survival analyses showed worse overall survival, cancer-specific mortality and other-cause mortality rates for patients receiving PBT(P 〈 0.001, P = 0.017 and P = 0.001, respectively). After IPTW adjustment, those differences no longer held true. PBT was not associated with recurrence-free survival (hazard ratio [HR] 0.92, 95% CI 0.53-1.58; P = 0.8), overall survival (HR 1.06, 95% CI 0.55-2.05; P = 0.9), cancer-specific mortality (sub-HR 1.09, 95% CI 0.62-1.92; P = 0.8) and other-cause mortality (sub-HR 1.00, 95% CI 0.26-3.85; P 〉 0.9) in IPTW-adjusted Cox regression and competing-risks analyses. The same held true in conventional multivariable Cox and competing-risks analyses, where PBT could not be confirmed as a predictor of any given endpoint (all P values 〉0.05).CONCLUSION: The present results did not show an adverse effect of PBT on oncological outcomes after adjusting for baseline differences in patient characteristics.
    Keywords: Medicine;
    ISSN: BJU International
    ISSN: 1464410X
    E-ISSN: 14644096
    E-ISSN: 1464410X
    Source: Wiley (via CrossRef)
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  • 3
    In: BJU International, January 2018, Vol.121(1), pp.101-110
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/bju.14012/abstract Byline: Malte W. Vetterlein, Philipp Gild, Luis A. Kluth, Thomas Seisen, Michael Gierth, Hans-Martin Fritsche, Maximilian Burger, Chris Protzel, Oliver W. Hakenberg, Nicolas Landenberg,Florian Roghmann, Joachim Noldus, Philipp Nuhn, Armin Pycha, Michael Rink, Felix K.-H. Chun, Matthias May, Margit Fisch,Atiqullah Aziz,, G Bartsch, C Bolenz, S Brookman-May, A Buchner, M Durschnabel, J Ellinger, M Froehner, G Georgieva, C Gilfrich, M Gorduk, MO Grimm, B Hadaschik, A Haferkamp, F Hartmann, E Herrmann, L Hertle, M Hohenfellner, G Janetschek, B Keck, N Kraischits, A Krausse, L Lusuardi, T Martini, MS Michel, R Moritz, SC Muller, V Novotny, S Pahernik, RJ Palisaar, A Ponholzer, J Roigas, M Schmid, P Schramek, C Seitz, D Sikic, CG Stief, I Syring, M Traumann, S Vallo, FM Wagenlehner, W Weidner, MP Wirth, B Wullich Keywords: blood transfusion; cystectomy; propensity score; recurrence; survival Objectives To evaluate the effect of peri-operative blood transfusion (PBT) on recurrence-free survival, overall survival, cancer-specific mortality and other-cause mortality in patients undergoing radical cystectomy (RC), using a contemporary European multicentre cohort. Patients and Methods The Prospective Multicentre Radical Cystectomy Series (PROMETRICS) includes data on 679 patients who underwent RC at 18 European tertiary care centres in 2011. The association between PBT and oncological survival outcomes was assessed using Kaplan-Meier, Cox regression and competing-risks analyses. Imbalances in clinicopathological features between patients receiving PBT vs those not receiving PBT were mitigated using conventional multivariable adjusting as well as inverse probability of treatment weighting (IPTW). Results Overall, 611 patients had complete information on PBT, and 315 (51.6%) received PBT. The two groups (PBT vs no PBT) differed significantly with respect to most clinicopathological features, including peri-operative blood loss: median (interquartile range [IQR]) 1000 (600-1500) mL vs 500 (400-800) mL (P 〈 0.001). Independent predictors of receipt of PBT in multivariable logistic regression analysis were female gender (odds ratio [OR] 5.05, 95% confidence interval [CI] 2.62-9.71; P 〈 0.001), body mass index (OR 0.91, 95% CI 0.87-0.95; P 〈 0.001), type of urinary diversion (OR 0.38, 95% CI 0.18-0.82; P = 0.013), blood loss (OR 1.32, 95% CI 1.23-1.40; P 〈 0.001), neoadjuvant chemotherapy (OR 2.62, 95% CI 1.37-5.00; P = 0.004), and a[yen]pT3 tumours (OR 1.59, 95% CI 1.02-2.48; P = 0.041). In 531 patients with complete data on survival outcomes, unweighted and unadjusted survival analyses showed worse overall survival, cancer-specific mortality and other-cause mortality rates for patients receiving PBT(P 〈 0.001, P = 0.017 and P = 0.001, respectively). After IPTW adjustment, those differences no longer held true. PBT was not associated with recurrence-free survival (hazard ratio [HR] 0.92, 95% CI 0.53-1.58; P = 0.8), overall survival (HR 1.06, 95% CI 0.55-2.05; P = 0.9), cancer-specific mortality (sub-HR 1.09, 95% CI 0.62-1.92; P = 0.8) and other-cause mortality (sub-HR 1.00, 95% CI 0.26-3.85; P 〉 0.9) in IPTW-adjusted Cox regression and competing-risks analyses. The same held true in conventional multivariable Cox and competing-risks analyses, where PBT could not be confirmed as a predictor of any given endpoint (all P values 〉0.05). Conclusion The present results did not show an adverse effect of PBT on oncological outcomes after adjusting for baseline differences in patient characteristics. Article Note: M.W.V. and P.G. contributed equally to the work. PROMETRICS 2011 Study Group members are present in Appendix 1.
    Keywords: Blood Transfusion ; Cystectomy ; Propensity Score ; Recurrence ; Survival
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 4
    Language: English
    In: The Journal of Urology, April 2016, Vol.195(4), pp.e538-e539
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2016.02.119 Byline: Atiqullah Aziz Author Affiliation: Hamburg, Germany Article Note: (footnote) Source of Funding: None
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 5
    Language: English
    In: Annals of Surgical Oncology, 2015, Vol.22(3), p.1032(11)
    Description: Byline: Marianne Schmid (1,2), Michael Rink (1), Miriam Traumann (1), Patrick J. Bastian (3), Georg Bartsch (4), Jorg Ellinger (5), Marc-Oliver Grimm (6), Boris Hadaschik (7), Axel Haferkamp (4), Oliver W. Hakenberg (8), Atiqullah Aziz (9), Florian Hartmann (6), Edwin Herrmann (10), Markus Hohenfellner (7), Gunter Janetschek (11), Michael Gierth (9), Sasc ha Pahernik (7), Chris Protzel (8), Jan Roigas (12), Murat Gorduk (12), Lukas Lusuardi (11), Matthias May (13), Quoc-Dien Trinh (2), Margit Fisch (1), Felix K.H. Chun (1) Abstract: Purpose The aim of this study was to examine preoperative patients' characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications. Materials In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011' (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates. Results Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3 % received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9 p = 0.002), American Society of Anesthesiologists score a[yen]3 (OR 2.3 p = 0.02), an age-adjusted Charlson Comorbidity Index a[yen]3 (OR 4.1 p 〈 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9 p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p 〈 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers. Conclusions Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type. Author Affiliation: (1) Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (2) Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (3) Department of Urology, Paracelsus Medical Center Golzheim, Dusseldorf, Germany (4) Department of Urology, Goethe University, Frankfurt am Main, Germany (5) Department of Urology, University of Bonn, Bonn, Germany (6) Department of Urology, University of Jena, Jena, Germany (7) Department of Urology, University of Heidelberg, Heidelberg, Germany (8) Department of Urology, University of Rostock, Rostock, Germany (9) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany (10) Department of Urology, University of Munster, Munster, Germany (11) Department of Urology, Paracelsus Medical University, Salzburg, Austria (12) Department of Urology, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany (13) Department of Urology, St. Elisabeth Medical Center, Straubing, Germany Article History: Registration Date: 09/08/2014 Received Date: 20/04/2014 Online Date: 28/08/2014 Article note: Marianne Schmid and Michael Rink contributed equally to this article. PROMETRICS 2011 Research Group: The PROMETRICS 2011 Research Group: Hans Martin Fritsche, Maximilian Burger, Roman Mayr (Regensburg) Rein-Juri Palisaar, Joachim Noldus, Florian Roghmann (Herne) Christian Bolenz, Thomas Martini, Maurice Stephan Michel (Mannheim) Armin Pycha (Bozen) Christian Seitz (Wien) Manfred Wirth, Vladimir Novotny, Michael Frohner (Dresden) Sabine Brookman-May, Christian G. Stief, Philipp Nuhn, Alexander Buchner (LMU Munchen) Melanie Durschnabel, Florian Wagenlehner, Wolfgang Weidner (Gie[sz]en) Lothar Hertle, Rudolf Moritz (Munster) Bastian Keck, Bernd Wullich (Erlangen) Stefan Vallo (Frankfurt) Nicole Kraischits (Salzburg) Annerose Krausse (Jena) Stefan C. Muller, Isabella Syring, Jorg Ellinger (Bonn).
    Keywords: Medical Research – Health Aspects ; Medical Research – Analysis ; Bladder Cancer – Health Aspects ; Bladder Cancer – Analysis
    ISSN: 1068-9265
    Source: Cengage Learning, Inc.
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  • 6
    Language: English
    In: European Urology Focus, March 2018, Vol.4(2), pp.252-259
    Description: The benefit of adjuvant chemotherapy (AC) for muscle-invasive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) is controversial. To assess the effectiveness of AC after RC for muscle-invasive UCB in contemporary European routine practice. By using a prospectively collected European multicenter database, we compared survival outcomes between patients who received AC versus observation after RC for locally advanced (pT3/T4) and/or pelvic lymph node–positive (pN+) muscle-invasive UCB in 2011. AC versus observation after RC. Inverse probability of treatment weighting (IPTW)–adjusted Cox regression and competing risks analyses were performed to compare overall survival (OS) as well as cancer-specific and other-cause mortality between patients who received AC versus observation. Overall, 224 patients who received AC ( = 84) versus observation ( = 140) were included. The rate of 3-yr OS in patients who received AC versus observation was 62.1% versus 40.9%, respectively ( = 0.014). In IPTW-adjusted Cox regression analysis, AC versus observation was associated with an OS benefit (hazard ratio: 0.47; 95% confidence interval [CI]: 0.25–0.86; = 0.014). In IPTW-adjusted competing risks analysis, AC versus observation was associated with a decreased risk of cancer-specific mortality (subhazard ratio: 0.51; 95% CI: 0.26–0.98; = 0.044) without any increased risk of other-cause mortality (subhazard ratio: 0.48; 95% CI: 0.14–1.60; = 0.233). Limitations include the relatively small sample size as well as the potential presence of unmeasured confounders related to the observational study design. We found that AC versus observation was associated with a survival benefit after RC in patients with pT3/T4 and/or pN+ UCB. These results should encourage physicians to deliver AC and researchers to pursue prospective or large observational investigations. Overall survival and cancer-specific survival benefit was found in patients who received adjuvant chemotherapy relative to observation after radical cystectomy for locally advanced and/or pelvic lymph node–positive bladder cancer. In this observational multicenter study, adjuvant chemotherapy versus observation after radical cystectomy for locally advanced and/or node-positive muscle-invasive urothelial bladder cancer was associated with an overall and cancer-specific survival benefit without increased risk of other-cause mortality.
    Keywords: Adjuvant Chemotherapy ; Cystectomy ; Propensity Score ; Survival ; Urinary Bladder Neoplasms ; Medicine
    ISSN: 2405-4569
    E-ISSN: 2405-4569
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  • 7
    Language: English
    In: Annals of Surgical Oncology, 2015, Vol.22(3), pp.1032-1042
    Description: PURPOSEThe aim of this study was to examine preoperative patients' characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications. MATERIALSIn 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011' (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates. RESULTSOf 570 eligible patients, 28.8, 2.6, 59.3, and 9.3% received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p 〈 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p 〈 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers. CONCLUSIONSWithin this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.
    Keywords: Aged–Adverse Effects ; Aged, 80 and Over–Mortality ; Comorbidity–Pathology ; Cystectomy–Surgery ; Female–Surgery ; Follow-Up Studies–Surgery ; Humans–Surgery ; Male–Surgery ; Middle Aged–Surgery ; Neoplasm Grading–Surgery ; Neoplasm Staging–Surgery ; Postoperative Complications–Surgery ; Prognosis–Surgery ; Prospective Studies–Surgery ; Quality of Life–Surgery ; Survival Rate–Surgery ; Urinary Bladder Neoplasms–Surgery ; Urinary Diversion–Surgery;
    ISSN: 1068-9265
    E-ISSN: 1534-4681
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  • 8
    Language: English
    In: World Journal of Urology, 2015, Vol.33(11), pp.1753-1761
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00345-015-1502-y Byline: Vladimir Novotny (1), Michael Froehner (1), Matthias May (2), Chris Protzel (3), Katrin Hergenrother (3), Michael Rink (4), Felix K. Chun (4), Margit Fisch (4), Florian Roghmann (5), Rein-Juri Palisaar (5), Joachim Noldus (5), Michael Gierth (6), Hans-Martin Fritsche (6), Maximilian Burger (6), Danijel Sikic (7), Bastian Keck (7), Bernd Wullich (7), Philipp Nuhn (8), Alexander Buchner (8), Christian G. Stief (8), Stefan Vallo (9), Georg Bartsch (9), Axel Haferkamp (9), Patrick J. Bastian (10), Oliver W. Hakenberg (3), Stefan Propping (1), Atiqullah Aziz (4) Keywords: Bladder cancer; Radical cystectomy; Recurrence; Outcome Abstract: Purpose To externally validate the Christodouleas risk model incorporating pathological tumor stage, lymph node (LN) count and soft tissue surgical margin (STSM) and stratifying patients who develop locoregional recurrence (LR) after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). In addition, we aimed to generate a new model including established clinicopathological features that were absent in the Christodouleas risk model. Methods Prospectively assessed multicenter data from 565 patients undergoing RC for UCB in 2011 qualified for final analysis. For the purpose of external validation, risk group stratification according to Christodouleas was performed. Competing-risk models were calculated to compare the cumulative incidences of LR after RC. Results After a median follow-up of 25 months (interquartile range 19--29), the LR-rate was 11.5 %. The Christodouleas model showed a predictive accuracy of 83.2 % in our cohort. In multivariable competing-risk analysis, tumor stage a[yen]pT3 (HR 4.32, p 〈 0.001), positive STSM (HR 2.93, p = 0.005), lymphovascular invasion (HR 3.41, p 〈 0.001), the number of removed LNs 〈10 (HR 2.62, p 〈 0.001) and the administration of adjuvant chemotherapy (HR 0.40, p = 0.008) independently predicted the LR-rate. The resulting risk groups revealed significant differences in LR-rates after 24 months with 4.8 % for low-risk patients, 14.7 % for intermediate-risk patients and 38.9 % for high-risk patients (p 〈 0.001 for all), with a predictive accuracy of 85.6 %, respectively. Conclusions The Christodouleas risk model has been successfully externally validated in the present prospective series. However, this analysis finds that overall model performance may be improved by incorporating lymphovascular invasion. After external validation of the newly proposed risk model, it may be used to identify patients who benefit from an adjuvant therapy and suit for inclusion in clinical trials. Author Affiliation: (1) Department of Urology, University Hospital "Carl Gustav Carus", Dresden, Germany (2) Department of Urology, St. Elisabeth Hospital, Straubing, Germany (3) Department of Urology, University Medical Center Rostock, Rostock, Germany (4) Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany (5) Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany (6) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany (7) Department of Urology, University Hospital Erlangen, Erlangen, Germany (8) Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany (9) Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany (10) Department of Urology, Paracelsus Medical Center Golzheim, Dusseldorf, Germany Article History: Registration Date: 27/01/2015 Received Date: 02/12/2014 Accepted Date: 25/01/2015 Online Date: 08/02/2015
    Keywords: Bladder cancer ; Radical cystectomy ; Recurrence ; Outcome
    ISSN: 0724-4983
    E-ISSN: 1433-8726
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  • 9
    Language: English
    In: Clinical Genitourinary Cancer, October 2017, Vol.15(5), pp.e809-e817
    Description: This prospective multicenter study analyzed the effect of hospital and surgeon case volume on perioperative quality of care and short-term complications and mortality in 479 patients undergoing radical cystectomy for bladder cancer. We found that hospital volume might represent an at least equally important factor regarding postoperative complications as the surgeon case volume itself at European tertiary care centers. Case volume has been suggested to affect surgical outcomes in different arrays of procedures. We aimed to delineate the relationship between case volume and surgical outcomes and quality of care criteria of radical cystectomy (RC) in a prospectively collected multicenter cohort. This was a retrospective analysis of a prospectively collected European cohort of patients with bladder cancer treated with RC in 2011. We relied on 479 and 459 eligible patients with available information on hospital case volume and surgeon case volume, respectively. Hospital case volume was divided into tertiles, and surgeon volume was dichotomized according to the median annual number of surgeries performed. Binomial generalized estimating equations controlling for potential known confounders and inter-hospital clustering assessed the independent association of case volume with short-term complications and mortality, as well as the fulfillment of quality of care criteria. The high-volume threshold for hospitals was 45 RCs and, for high-volume surgeons, was 〉 15 cases annually. In adjusted analyses, high hospital volume remained an independent predictor of fewer 30-day (odds ratio, 0.34;  = .002) and 60- to 90-day (odds ratio, 0.41;  = .03) major complications but not of fulfilling quality of care criteria or mortality. No difference between surgeon volume groups was noted for complications, quality of care criteria, or mortality after adjustments. The coordination of care at high-volume hospitals might confer a similar important factor in postoperative outcomes as surgeon case volume in RC. This points to organizational elements in high-volume hospitals that enable them to react more appropriately to adverse events after surgery.
    Keywords: High Volume ; Postoperative Complications ; Quality of Health Care ; Urinary Bladder Neoplasms ; Volume-Outcome Relationship ; Medicine
    ISSN: 1558-7673
    E-ISSN: 1938-0682
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