title: Two-surgeon versus single-surgeon radical cystectomy and urinary diversion: impact on patient outcomes and costs.
abstract: OBJECTIVE
  To examine the difference in charges and outcomes between patients who underwent radical cystectomy and urinary diversion by a team of two surgeons versus a single surgeon.
  
  
  METHODS
  A total of 63 patients with bladder cancer who underwent the procedures were retrospectively analyzed. Two surgeons sequentially performed the cystectomy and ileal conduit (IC, n = 17) or neobladder (NBL, n = 18) or a single surgeon performed both the cystectomy and IC (n = 21) or NBL (n = 7). Procedure-related charges, hospital charges, operating room time, length of stay, and complications were compared between the two groups.
  
  
  RESULTS
  For the IC patients, the two-surgeon team had 60% greater mean surgeon charges (P <0.0001), 23% lower mean anesthesia charges (P <0.0001), 121 minutes shorter operating room time (P = 0.001), and 30% lower operating room charges (P = 0.001). For the NBL patients, the two-surgeon team had 32% greater surgeon charges (P <0.0001), 22% lower anesthesia charges (P = 0.003), 149 minutes shorter operating room time (P <0.0001), and 41% less operating room charges (P <0.0001). No differences were found in total hospital charges. The NBL patients who underwent surgery by two surgeons had a longer length of stay (P = 0.008). No differences were found in complications between the groups.
  
  
  CONCLUSIONS
  For IC patients, our data showed no differences in the average overall charges, whether a two-surgeon team or a single surgeon performed the procedure. Additional reductions in hospital charges could offset the greater physician charges in the NBL patients and allow full realization of the benefit from the shorter operative time with the two-surgeon team.
authors.affiliation: Department of Urology, University of Iowa College of Medicine, Iowa City, Iowa 52242-1089, USA.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Ludwig
authors.forename: Lavanya
authors.initials: L
authors.lastname: Inampudi
authors.forename: Michael A
authors.initials: MA
authors.lastname: O'Donnell
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Kreder
authors.forename: Richard D
authors.initials: RD
authors.lastname: Williams
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000191:economics* / Q000379:methods*