Presentation Authors: Ana Guijarro*, Carlos Llorente, Virginia Hernandez, Elia Pérez- Férnandez, Guillermo fernandez Conejo, Enrique De la Peña, Madrid, Spain
Introduction: Mortality of Radical cystectomy (RC) differs in the literature from as low as 2.3% for a 90-day mortality in a single institution, to as high as 7.9% for a prospective multi-institutional series or 5% for a retrospective review of administrative population-based database. 90-day mortality rate of RC in a nation-wide population-based study has not been explored._x000D_
The aim of this study is to investigate 90-day mortality rate of RC for bladder cancer in a nation-wide population-based study, and to evaluate the effect of number of RC per hospital on the surgical outcomes.
Methods: We used mandatory hospital discharge forms (CMBD) of all patients submitted to RC due to bladder cancer in Spain during 2011-2015. Morbidity and mortality were assessed using discharge codes of the primary admission or any other registered admission up to 3 months after the procedure. Demographics of patients including age, sex, and Charlson comorbidity score as well as hospital size and number of RCs/year have also been recorded._x000D_
We calculated in-hospital, 30-, 60- and 90-day mortality. Average annual RC volume was used as a continuous variable (log-transformed) and also grouped into deciles in order to identify any potential non-linear relationships. Logistic regression model with mixed effect was performed adjusting for year of surgery, comorbidity, surgical approach, type of admission, age, sex, and hospital size.
Results: A total of 12154 RC were operated on in 196 hospitals. 87.2% of the patients were males, mean age was 68.1 years (SD 9.8). 88.9% of the cases received open surgery, 10% laparoscopic surgery and 1.2% robot-assisted surgery. Most hospitals (110) performed
Conclusions: In the setting of a nation-wide population-based study we report a mortality rate comparable to previous multi-institutional studies. Our study identifies an inverse association between 90- day mortality and hospital volume. The lack of centralization for RC is of concern in that low-volume centers have a mortality higher than high-volume centers. This would have a more pronounced benefit for patients at high-risk.