To establish the current standard for open radical cystectomy (ORC) in England, as data entry by surgeons performing RC to the British Association of Urological Surgeons (BAUS) database was mandated in 2013 and combining this with Hospital Episodes Statistics (HES) data has allowed comprehensive outcome analysis for the first time.
All patients were included in this analysis if they were uploaded to the BAUS data registry and reported to have been performed in the 2 years between 1 January 2014 and 31 December 2015 in England (from mandate onwards) and had been documented as being performed in an open fashion (not laparoscopic, robot assisted or the technique field left blank). The HES data were accessed via the HES website. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures version 4 (OPCS-4) Code M34 was searched during the same 2-year time frame (not including M34.4 for simple cystectomy or with additional minimal access codes Y75.1-9 documenting a laparoscopic or robotic approach was used) to assess data capture.
A total of 2 537 ORCs were recorded in the BAUS registry and 3 043 in the HES data. This indicates a capture rate of 83.4% of all cases. The median operative time was 5 h, harvesting a median of 11-20 lymph nodes, with a median blood loss of 500-1 000 mL, and a transfusion rate of 21.8%. The median length of stay was 11 days, with a 30-day mortality rate of 1.58%.
This is the largest, contemporary cohort of ORCs in England, encompassing >80% of all performed operations. We now know the current standard for ORC in England. This provides the basis for individual surgeons and units to compare their outcomes and a standard with which future techniques and modifications can be compared.
BJU international. 2018 Feb 16 [Epub]
Edward R Jefferies, Joanne Cresswell, John S McGrath, Catherine Miller, Luke Hounsome, Sarah Fowler, Edward W Rowe, BAUS Section on Oncology
Department of Urology, Royal United Hospital, Bath, UK., Department of Urology, James Cook University Hospital, Middlesbrough, UK., Department of Urology, Royal Devon and Exeter Hospital, Exeter, UK., Public Health England Knowledge and Intelligence Team (South West), Bristol, UK., British Association of Urological Surgeons, Bristol, UK., Bristol Urological Institute, Southmead Hospital, Bristol, UK.