Patient preference and adherence, 2016, Vol.10, pp.2181-2187
This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery. A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy. Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien-Dindo classification. Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (70 years, ≤0.001) tumor grade (low grade, 〈0.001; high grade, ≤0.001), and UD (ileal conduit, 〈0.001; neobladder, 〈0.001). In a multivariable analysis, age (=0.031) and type of UD (=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (=0.0417), age (=0.041), and the time periods (A/B) (〈0.001) show a significant association with the presence of complications. This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic outcome and quality of life.
Clavien–Dindo Classification ; Ud ; Early Complications ; High-Volume Period ; Low-Volume Period ; Radical Cystectomy ; Urinary Diversion
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