Beschreibung:
286 Background: NICE-Improving Outcomes in Urological cancers (2002) recommended that providers in UK carry out a cumulative total of at least 50 radical cystectomies or prostatectomies per year. Surgeons should perform ≥5 cystectomies per year and 30-day mortality rates of 3.5% or less must be achieved. We evaluated this effect of centralisation on cystectomy outcomes over the past decade. Methods: The Health Episode Statistic (HES) database for cystectomies in England over a period of 2001 to 2012 for patients with bladder cancer was interrogated. Banded provider volumes (<10, ≥10 to < 16, ≥16) and surgeon volumes (<5, ≥5 to <8, ≥8) with respect to age, sex, Charlsons’ comorbidity index, deprivation index are presented with outcomes related to 30, 60, 90 day mortality; length of stay (LOS); re-admission; complications; operation specific re-intervention; and overall survival related outcome data is analysed. Results: 14,693 cystectomies for bladder cancer were performed over the study period. 85.5% providers (35% of all cystectomies) and 70.9% Surgeons (40% of all cystectomies) were performing less than the recommend standard prior to the NICE 2002 recommendations. A decade later 50% providers (3.5% of all cystectomies) and 42% surgeons continue to perform less than the recommended standard but only 12.5% of all cystectomes were carried in non-compliant centres/surgeons. The 30-day mortality rate fell from 3.7% to 2.4%. There was no difference in age, sex or deprivation scores amongst the bands for providers/surgeons. However, high volume providers and surgeons operated on patients with higher comorbidity scores but achieved shorter LOS. No difference in complications was seen amongst the bands, but re-intervention rates were higher amongst low volume surgeons. Mortality (early and overall) was lower in high volume provider and surgeons when compared to low bands. Conclusions: The UK data suggests 87.5% cystectomies are carried out in a compliant centre indicative of centralisation. The 30-day mortality rates have fallen. Overall mortality is lower in high volume providers and surgeons despite these groups with higher co-morbidity scores reflective of improved service provision through centralisation.