title: Time trends in prostate cancer surgery: data from an Internet-based multicentre database.
abstract: OBJECTIVE
  To report our experience with an Internet-based multicentre database that enables tumour documentation, as well as the collection of quality-related parameters and follow-up data, in surgically treated patients with prostate cancer. The system was used to assess the quality of prostate cancer surgery and to analyze possible time-dependent trends in the quality of care.
  
  
  METHODS
  An Internet-based database system enabled a standardized collection of treatment data and clinical findings from the participating urological centres for the years 2005-2009. An analysis was performed aiming to evaluate relevant patient characteristics (age, pathological tumour stage, preoperative International Index of Erectile Function-5 score), intra-operative parameters (operating time, percentage of nerve-sparing operations, complication rate, transfusion rate, number of resected lymph nodes) and postoperative parameters (hospitalization time, re-operation rate, catheter indwelling time). Mean values were calculated and compared for each annual cohort from 2005 to 2008. The overall survival rate was also calculated for a subgroup of the Berlin patients.
  
  
  RESULTS
  A total of 914, 1120, 1434 and 1750 patients submitted to radical prostatectomy in 2005, 2006, 2007 and 2008 were documented in the database. The mean age at the time of surgery remained constant (66 years) during the study period. More than half the patients already had erectile dysfunction before surgery (median International Index of Erectile Function-5 score of 19-20). During the observation period, there was a decrease in the percentage of pT2 tumours (1% in 2005; 64% in 2008) and a slight increase in the percentage of patients with lymph node metastases (8% in 2005; 10% in 2008). No time trend was found for the operating time (142-155 min) or the percentage of nerve-sparing operations (72-78% in patients without erectile dysfunction). A decreasing frequency was observed for the parameters: blood transfusions (1.9% in 2005; 0.5% in 2008), postoperative bleeding (2.6%; 1.2%) and re-operations (4.5%; 2.8%). The mean hospitalization time decreased accordingly (10 days in 2005; 8 days in 2008). The examined subcohort had an overall mortality of 1.5% (median follow-up of 3 years).
  
  
  CONCLUSIONS
  An Internet-based database system for tumour documentation in patients with prostate cancer enables the collection and assessment of important parameters for the quality of care and outcomes. The participating centres show an improvement in the quality of surgical management, including a reduction of the complication rate.
authors: Charité, Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany. martin.schostak@med.ovgu.de
authors: Martin
authors: M
authors: Schostak
authors: Daniel
authors: D
authors: Baumunk
authors: Anita
authors: A
authors: Jagota
authors: Christian
authors: C
authors: Klopf
authors: Alexander
authors: A
authors: Winter
authors: Sebastian
authors: S
authors: Schäfers
authors: Robert
authors: R
authors: Kössler
authors: Volker
authors: V
authors: Brennecke
authors: Tom
authors: T
authors: Fischer
authors: Susanne
authors: S
authors: Hagel
authors: Steffen
authors: S
authors: Höchel
authors: Dierk
authors: D
authors: Jäkel
authors: Mike
authors: M
authors: Lehsnau
authors: Susanne
authors: S
authors: Krege
authors: Bernd
authors: B
authors: Rüffert
authors: Jana
authors: J
authors: Pretzer
authors: Eduard
authors: E
authors: Becht
authors: Thomas
authors: T
authors: Zegenhagen
authors: Kurt
authors: K
authors: Miller
authors: Steffen
authors: S
authors: Weikert
mesh_terms: D000368:Aged; D003625:Data Collection; D019992:Databases as Topic; D005858:Germany; D006801:Humans; D020407:Internet; D007902:Length of Stay; D008297:Male; D011468:Prostatectomy / Q000592:standards / Q000639:trends*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life