Christer Groeben1, Rainer Koch2, Martin Baunacke3, Angelika Borkowetz3, Manfred P Wirth3, Johannes Huber3. 1. Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany, Christer.Groeben@uniklinikum-dresden.de. 2. Department of Medical Statistics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany. 3. Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
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.
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.
Authors: Frederik König; Benjamin Pradere; Nico C Grossmann; Fahad Quhal; Pawel Rajwa; Ekaterina Laukhtina; Keiichiro Mori; Satoshi Katayama; Takafumi Yanagisawa; Hadi Mostafai; Reza Sari Motlagh; Abdulmajeed Aydh; Roland Dahlem; Shahrokh F Shariat; Michael Rink Journal: Transl Cancer Res Date: 2022-04 Impact factor: 1.241
Authors: Markus Maier; Anne-Karoline Ebert; Martin Baunacke; Christer Groeben; Nicole Eisenmenger; Christian Thomas; Johannes Huber Journal: Urologe A Date: 2021-09-15 Impact factor: 0.639