Urologist referral delay and its impact on survival after radical cystectomy for XXXX .

@entity1 @entity150 @entity204
BACKGROUND: Evidence shows that wait times before @entity150 surgery have been increasing, and wait time can negatively affect survival. We aimed to determine if a long delay caused by an indirect referral before a first urologist visit affects the survival of @entity1 undergoing radical cystectomy for @entity150 . METHODS: We analyzed data from 1271 @entity1 who underwent surgery for @entity150 during the decade 2000-2009. The cohort was obtained by linking two administrative databases in the province of Quebec. @entity1 were considered to have been directly referred to a urologist if they had 5 or fewer visits with a general practitioner before their first urologist visit; otherwise, they were considered to have been indirectly referred. The effect on survival after surgery of a longer delay before a first urologist visit was assessed using Cox regression models. RESULTS: Median referral delay for the study population was 30 days (56 days for @entity1 , 23 days for @entity1 ; p < 0.0001). Indirect referral was observed for 49% of @entity1 and 33% of @entity1 . Compared with @entity1 who were directly referred, those who were indirectly referred after first symptoms of @entity150 experienced poorer survival (hazard ratio: 1.29; 95% confidence interval: 1.10 to 1.52). @entity1 who were indirectly referred had a significant 47% greater risk of @entity204 after radical cystectomy. @entity1 who were indirectly referred also experienced decreased survival (adjusted hazard ratio: 1.25; 95% confidence interval: 1.03 to 1.51). CONCLUSIONS: @entity1 indirectly referred to a urologist had an increased risk of mortality after surgery. Compared with @entity1 , @entity1 had longer wait times and poorer survival.
