The BAUS radical cystectomy audit 2014/2015 - an update on current practice and an analysis of the effect of centre and surgeon case volume

Author(s):
Mr Sinan Khadhouri
,
Mr Sinan Khadhouri
Affiliations:
Miss Catherine Miller
,
Miss Catherine Miller
Affiliations:
Miss Joanna Cresswell
,
Miss Joanna Cresswell
Affiliations:
Mr Edward Rowe
,
Mr Edward Rowe
Affiliations:
Mr Luke Hounsome
,
Mr Luke Hounsome
Affiliations:
Ms Sarah Fowler
,
Ms Sarah Fowler
Affiliations:
Mr John McGrath
Mr John McGrath
Affiliations:
BAUS ePoster online library. Khadhouri S. 06/26/17; 177339; P1-11
Mr. Sinan Khadhouri
Mr. Sinan Khadhouri
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Abstract
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On behalf of the BAUS Section of Oncology

Introduction

The Consultant Outcome Publication has made it mandatory in England to submit surgeon-level data on radical cystectomy (RC) practice. The current analysis describes contemporary surgical practice and compares this by surgeon and centre case-volume.

Methods

Between 01/01/2014 – 31/12/2015 data on 3742 RCs performed by 161 surgeons over 84 centres were recorded on the BAUS audit and data platform.
Centre case-volumes were grouped in to high (>60), medium (30-60) and low (<30); surgeon case-volumes in to high (>30), medium (8-30) and low (<8). All data averages were for the combined two year period. Groups were compared to analyse differences in surgical practice and associated outcomes.

Results

Median number of RCs performed was 16/surgeon and 31/centre. 45.4% of cases were performed for muscle-invasive TCC.

Table 1

Urinary diversion performed were ileal conduit (85.2%), orthotopic bladder substitution (5.7%), continent cutaneous (1.5%) and rectal diversions (0.2%) respectively.

Table 2

Conclusions

ORC remains the commonest surgical approach. RARC is more commonly offered by high case-volume surgeons and centres. Reported transfusion rates differ between high and low case-volume centres. LND is more commonly performed by high case-volume surgeons.
LOS is shorter in RARC and LRC in comparison to ORC but is otherwise similar across centres and surgeons.
Reported post-operative mortality is variable between case-volume centres and surgeons.
PSM are largely similar across centres and surgeons. There is no obvious association between case-volume and higher grade Clavien-Dindo complications (≥3) but under-reporting is highly likely.
On behalf of the BAUS Section of Oncology

Introduction

The Consultant Outcome Publication has made it mandatory in England to submit surgeon-level data on radical cystectomy (RC) practice. The current analysis describes contemporary surgical practice and compares this by surgeon and centre case-volume.

Methods

Between 01/01/2014 – 31/12/2015 data on 3742 RCs performed by 161 surgeons over 84 centres were recorded on the BAUS audit and data platform.
Centre case-volumes were grouped in to high (>60), medium (30-60) and low (<30); surgeon case-volumes in to high (>30), medium (8-30) and low (<8). All data averages were for the combined two year period. Groups were compared to analyse differences in surgical practice and associated outcomes.

Results

Median number of RCs performed was 16/surgeon and 31/centre. 45.4% of cases were performed for muscle-invasive TCC.

Table 1

Urinary diversion performed were ileal conduit (85.2%), orthotopic bladder substitution (5.7%), continent cutaneous (1.5%) and rectal diversions (0.2%) respectively.

Table 2

Conclusions

ORC remains the commonest surgical approach. RARC is more commonly offered by high case-volume surgeons and centres. Reported transfusion rates differ between high and low case-volume centres. LND is more commonly performed by high case-volume surgeons.
LOS is shorter in RARC and LRC in comparison to ORC but is otherwise similar across centres and surgeons.
Reported post-operative mortality is variable between case-volume centres and surgeons.
PSM are largely similar across centres and surgeons. There is no obvious association between case-volume and higher grade Clavien-Dindo complications (≥3) but under-reporting is highly likely.
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