title: Performance comparisons in major uro-oncological surgeries between the USA and Japan.
abstract: OBJECTIVE
  To elucidate the differences in clinical practice between the USA and Japan in major types of uro-oncological surgery by a head-to-head comparison of national databases in the two countries.
  
  
  METHODS
  We compared variations in surgical modality, length of stay, total charges, caseload centralization, transfusion incidence, and in-hospital mortality between the two countries for four major types of uro-oncological surgery (radical prostatectomy, radical cystectomy, nephrectomy and nephroureterectomy) in 2011. Additionally, the chronological changes in surgical modalities were investigated for 2009-11. The national estimates were based on data from the Japanese Diagnosis Procedure Combination database and the US National Inpatient Sample.
  
  
  RESULTS
  For radical prostatectomy, radical cystectomy, nephrectomy and nephroureterectomy, minimally-invasive surgery accounted for 24.2% versus 70.2%, 0% versus 14.0%, 50.7% versus 30.7% and 50.2% versus 30.5%, respectively, in Japan versus the USA in 2011. Although minimally-invasive surgery has become increasingly frequent in both countries, the major procedures were robot-assisted surgery in the USA and laparoscopic surgery in Japan. The USA was generally characterized by a slightly younger age at operation, far higher hospital volume, a shorter length of stay, higher charges and less use of transfusion than Japan.
  
  
  CONCLUSIONS
  The findings suggest substantial differences between the USA and Japan regarding clinical practices in uro-oncological surgery. Standing at the beginning of robotic surgery era in Japan, the precise recognition of these differences will aid a proper understanding of clinical practices.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Urology, The University of Tokyo, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Jarrod E
authors.initials: JE
authors.lastname: Dalton
authors.forename: Jesse
authors.initials: J
authors.lastname: Schold
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D016208:Databases, Factual; D006801:Humans; D007564:Japan; D014481:United States; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data*
keywords: cross-cultural comparison; nephrectomy; nephroureterectomy; prostatectomy; radical cystectomy