Introduction: The British Association of Urological Surgeons (BAUS) complex operations database for radical cystectomy (RC) is a national repository of mandated RC data, made publicly available via the ‘Clinical Outcomes Publication (COP)’. A near complete and detailed dataset exists for RC practice across England, providing contemporary benchmarking data to both patients and professionals.
Objectives: -To produce comprehensive and detailed RC benchmarking data to deliver transparency for patients and a reference resource for surgeons.
Methods: BAUS manage the complex operations database for RC. Surgical departments upload data (22 nationally mandated fields and 84 in total) pertaining to patient, disease, surgical, pathological and outcome descriptors. Surgeons can review and amend their data before lockdown and data cleansing. Analysis of 2016-18 data was performed for 5,288 patients undergoing RC in England.
Results: Using Hospital episode statistics (HES) as the comparator, the BAUS RC dataset for England (2016-18) was deemed to be 93% complete. Median patient age was 70 (IQR 62 – 75), and 75% were male. Charlson comorbidity index of =2 was reported in 66%. RCs were performed as primary treatment of muscle-invasive bladder cancer (MIBC) in 44%, with 31% performed for non-muscle invasive bladder cancer (NMIBC). The commonest disease stages were T2N0 (30%) and T1N0 (21%). Table 1 summarises surgical and outcome descriptors. Conversion rate for RARC was 5%. High (>60) and low (<30) annual volume centres each accounted for 29% of RCs. Post-operative histology upstaged 22% of cases and downstaged 23%. NMIBC and MIBC were lymph node positive in 7% and 22% of cases respectively.
Conclusions: Analysis of this comprehensive and highly complete dataset offers the first set of UK national RC standards against which surgeons can compare their practice. It allows procedure, patient and disease-specific comparison against national trends and outcomes. Adoption of technology and specific aspects of surgical practice can be observed, including operative modality, LND and reconstruction techniques. Public facing analysis of this dataset will enhance informed patient decision-making. Source of
