PD52-09 TENDENCIES OF CENTRALIZATION FOR RADICAL RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER: RESULTS OF TOTAL-POPULATION-DATA ANALYSIS IN GERMANY FROM 2006 TO 2014

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making III1 Apr 2018PD52-09 TENDENCIES OF CENTRALIZATION FOR RADICAL RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER: RESULTS OF TOTAL-POPULATION-DATA ANALYSIS IN GERMANY FROM 2006 TO 2014 Christer Groeben, Rainer Koch, Martin Baunacke, Manfred P. Wirth, and Johannes Huber Christer GroebenChrister Groeben More articles by this author , Rainer KochRainer Koch More articles by this author , Martin BaunackeMartin Baunacke More articles by this author , Manfred P. WirthManfred P. Wirth More articles by this author , and Johannes HuberJohannes Huber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical retroperitoneal lymph node dissection (RPLND) is a standard treatment in the management of metastatic germ cell tumours. However, due to modified algorithms it has become less frequent. Aim of our study was to analyse the current trends and treatment patterns for RPLND in Germany. METHODS By using remote data processing we analysed the nationwide German hospital billing data from 2006 to 2014. All cases with a testicular cancer diagnosis combined with RPLND were eligible for evaluation. We assessed the length of hospital stay, blood transfusion rates and in-hospital mortality stratified for surgical approach, hospital characteristics, and annual caseload. We classified annual hospital caseload as high (>10 RPLND/year), medium (3-9 RPLND/year), and low (<3 RPLND/year). RESULTS Total number of RPLND included was 3,913 with decreasing annual caseload numbers from 540 in 2006 to 400 in 2014. Patients' mean age was 34.2 ± 10.7 years. Of all RPLND, high volume hospitals performed 19.5%, medium volume hospitals 46.7%, and low volume hospitals 33.9%. The share of all RPLND performed in hospitals with high volume increased from 13.7% to 22.0% during the study period (p=0.001). The share of open surgery declined from 85.7% to 80.2% while laparoscopy increased from 14.3% to 17.5% and robotics from 0% to 2.9%. The mean length of stay was longer for open vs. laparoscopic RPLND (11.9 ± 8.8 vs. 7.4 ± 5.4 days, p<0.0001). High volume hospitals showed a shorter length of stay with 10.6 ± 8.2 days vs. 11.5 ± 10.1 days (medium volume; p=0.026), and 11.3 ± 5.9 days (low volume) (p=0.059). The overall blood transfusion rate was 17.6%. Overall in-hospital mortality was 0.6%. CONCLUSIONS Total numbers of RPLND have declined by about 25% in Germany from 2006 to 2014. The share of laparoscopic and robotic RPLND is slowly increasing. Laparoscopic RPLND and hospitals with high annual caseload volumes achieve shorter hospital stays. There is a trend towards centralization of care in hospitals with higher annual caseloads. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e984-e985 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christer Groeben More articles by this author Rainer Koch More articles by this author Martin Baunacke More articles by this author Manfred P. Wirth More articles by this author Johannes Huber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...