In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014.

Abstract:

BACKGROUND:Radical cystectomy (RC) still poses a significant risk for mortality and morbidity. OBJECTIVES:We compared in-hospital outcomes after RC in the United States and -Germany using population-based data. METHODS:We compared data from the US Nationwide Inpatient Sample to the German hospital billing database. Mortality and transfusion during hospital stay and length of stay (LOS) were evaluated. RESULTS:In all, 17,711 (the United States) and 60,447 (-Germany) cases were included. The share of robot-assisted RC increased to 20.5% in the United States vs. 2.3% in Germany (p < 0.001). In-hospital mortality was 1.9% (the United States) vs. 4.6% (Germany), transfusion rates were 34.2% (the United States) vs. 58.7% (Germany), and LOS was 10.7 (the United States) vs. 25.1 days (Germany; all p < 0.001). On multivariate analysis, higher patient age and lower annual hospital caseload were associated with increased mortality and longer LOS. Minimal-invasive surgery was associated with less blood transfusion and shorter LOS in the United States vs. hospital caseload and choice of urinary diversion in Germany. CONCLUSIONS:Healthcare systems might exert a relevant impact on outcomes of oncologic surgery. Increased in-hospital mortality rates in Germany seem to be partly explained by much longer LOS compared to those in the United States. Annual caseload seems to be influential on in-hospital outcomes raising the question of centralization of RC.

journal_name

Urol Int

journal_title

Urologia internationalis

authors

Groeben C,Koch R,Baunacke M,Borkowetz A,Wirth MP,Huber J

doi

10.1159/000496347

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

284-292

issue

3

eissn

0042-1138

issn

1423-0399

pii

000496347

journal_volume

102

pub_type

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