Disparities in access to high-volume centers and in hospital discharge status following radical cystectomy in Florida.

INTRODUCTION: Centralization of radical cystectomy (RC) improves outcomes but may unintentionally exacerbate existing disparities in care. Our objective was to assess disparities in access to high-volume RC centers and in postoperative recovery. METHODS: We identified RC patients in the Florida Inpatient Data File from 2013 to 2019. Hospital annual cystectomy volume was categorized as low, medium, or high using data-derived 75th and 90th quantiles: <5, 5 to 13, and >13 RC/year. Outcomes included inpatient mortality, non-home discharge, in-hospital complications, length of stay (LOS) and surgery in a low-volume hospital. Mixed-effects regression models accounting for clustering within centers were utilized. RESULTS: Among 4,396 patients treated at 105 centers, RC at a high-volume center was associated with lower odds of mortality, non-home discharge, shorter length of stay and fewer complications (all P ≤ 0.001). Characteristics associated with receiving care in a low-volume hospital included Black race (OR 1.67, 95% CI 1.14-2.39), Hispanic/Latino ethnicity (OR 1.74, 95% CI 1.32-2.00), and residing in northeast (OR 2.11, 95% CI 1.58-2.80) or west Florida (OR 1.34, 95% CI 1.05-1.71). Black patients had increased odds of non-home discharge (OR 1.91, 95% CI 1.27-2.86) and longer LOS (IRR 1.17, 95% CI 1.08-1.27), but no difference in the rate or number of postoperative complications (P > 0.2). CONCLUSION: In Florida, we observed racial and geographic disparities in likelihood of undergoing RC at a high-volume hospital, and that Black patients experienced longer LOS and lower odds of home discharge despite similar rates of complications. Efforts to increase access to high-value RC care for these vulnerable populations are needed.