What should be the patient's preference regarding the choice of hospital in the case of radical cystectomy? Evaluation of early complications after open radical cystectomy in a medium and high volume setting in one hospital.
OBJECTIVE
This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery.


OBJECTIVE
A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy.


METHODS
Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien-Dindo classification.


RESULTS
Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (P<0.001). When placing patients into subgroups, significantly more complications in period A were also seen concerning sex (male,P<0.001; female,P=0.003), age (<70 years,P<0.001; >70 years,P≤50.001) tumor grade (low grade,P<0.001; high grade,P≤0.001), and UD (ileal conduit,P<0.001; neobladder,P<0.001). In a multivariable analysis, age (P=0.031) and type of UD (P=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (P=0.0417), age (P=0.041), and the time periods (A/B) (P<0.001) show a significant association with the presence of complications.


CONCLUSIONS
This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic outcome and quality of life.
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Jens
J
Mani
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Stefan
S
Vallo
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Maximilian P
MP
Brandt
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Kilian M
KM
Gust
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Claudia
C
Bartsch
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Johannes
J
Daechert
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Igor
I
Tsaur
Department of Urology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany.
Georg
G
Bartsch
Department of Urology, Goethe University Hospital, Frankfurt am Main.
Axel
A
Haferkamp
Clavien–Dindo classification; UD; early complications; high-volume period; low-volume period; radical cystectomy; urinary diversion