Abstract
ABSTRACTObjective:To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center.Methods:This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay.Results:A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate.Conclusion:There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.
Highlights
IntroductionRadical cystectomy (RC) is the mainstay of treatment for muscle-invasive bladder cancer (MIBC) and is the standard by which other treatments are judged.[1]
Radical cystectomy (RC) is the mainstay of treatment for muscle-invasive bladder cancer (MIBC) and is the standard by which other treatments are judged.[1]. Radical cystectomy figures among the treatment options for selected patients with non-muscle invasive bladder cancer (BC) and in patients with locally advanced or metastatic BC with major clinic response to cisplatin-based chemotherapy.[2]. Despite several improvements in surgical technique and perioperative care that have impact on MIBC surgical treatment,(3) RC is still regarded as a high-risk procedure
Several studies have indicated a correlation of both hospital and surgeon volume with outcomes from treatment for various diseases.[6]. In the complex setting of MIBC surgical treatment, data indicate that complication and mortality rates after RC decrease with increasing surgeon volume.[6,7,8,9,10,11] These findings have led to the creation of guidelines and protocols favoring centralizing high-volume centers for BC treatment in the United Kingdom, which have significantly improved the outcomes.[12]
Summary
Radical cystectomy (RC) is the mainstay of treatment for muscle-invasive bladder cancer (MIBC) and is the standard by which other treatments are judged.[1]. BC patients commonly present cardiovascular comorbidities and tobacco-associated conditions, such as chronic pulmonary diseases, which might contribute to higher mortality and complications rates after surgery. Several studies have indicated a correlation of both hospital and surgeon volume with outcomes from treatment for various diseases.[6] In the complex setting of MIBC surgical treatment, data indicate that complication and mortality rates after RC decrease with increasing surgeon volume.[6,7,8,9,10,11] These findings have led to the creation of guidelines and protocols favoring centralizing high-volume centers for BC treatment in the United Kingdom, which have significantly improved the outcomes.[12].
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