Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3502–3509 | Cite as

Urinary Diversion After Radical Cystectomy for Bladder Cancer: Comparing Trends in the US and Germany from 2006 to 2014

  • Christer Groeben
  • Rainer Koch
  • Martin Baunacke
  • Marianne Schmid
  • Angelika Borkowetz
  • Manfred P. Wirth
  • Johannes Huber
Urologic Oncology

Abstract

Objective

Our aim was to assess and compare trends of urinary diversion (UD) for patients receiving radical cystectomy for the treatment of bladder cancer in the US and Germany, and to investigate decisive predictors for the choice of UD.

Methods

We analyzed the nationwide German hospital billing database and the Nationwide Inpatient Sample (NIS) from 2006 to 2014. Cases with a bladder cancer diagnosis combined with RC were included, and trends in the choice of UD, transfusion rates, length of stay, and mortality were assessed.

Results

From 2006 to 2014, the total number of RCs recorded within the NIS were 17,711, with a varying annual caseload of 1666–2009, while RC numbers increased from 5627 to 7390 in Germany (p < 0.001 for trends), with a total of 60,447 cases. The share of incontinent UD in the US remained stable at 93%, while increasing from 63.2 to 70.8% in Germany. Multivariate models indicated age and sex were the most important factors associated with the choice of UD in both countries, while hospital caseload and teaching status were less relevant factors in the US. In-hospital mortality was lower in the US compared with Germany (1.9% vs. 4.6%; p < 0.001), with significantly shorter hospital stays (10.7 days in the US vs. 25.1 days in Germany; p < 0.001).

Conclusions

The increasing age of patients with presumably higher comorbidity in recent years led to increased use of incontinent UD in Germany, while continent UD appears to be underused in the US. Mortality and transfusion rates were significantly lower in the US within a shorter hospital stay.

Notes

Acknowledgment

Data Source

US Nationwide Inpatient Sample and German research data centers of the federal and state statistical offices, DRG statistics 2006–2014, and our own calculations. The authors thank Stefanie Uhrich and Melanie Scheller for supporting data retrieval. Part of this study was presented at the 32nd Annual Meeting of the European Association of Urology, London, UK, 24–28 March 2017.

Funding

Med-Drive Grant of the Medical Faculty Carl Gustav Carus TU Dresden. (Grant Number 60.356).

Disclosure

Dr. Huber reports personal fees from Amgen and Janssen, and grants and nonfinancial support from Intuitive Surgical and Takeda, outside the submitted work. Christer Groeben, Rainer Koch, Martin Baunacke, Marianne Schmid, and Manfred P. Wirth declare that they have no conflicts of interest.

References

  1. 1.
    Aziz A, May M, Burger M, et al. Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol. 2014: 66:156–163.CrossRefGoogle Scholar
  2. 2.
    Hollenbeck BK, Wei Y, Birkmeyer JD. Volume, process of care, and operative mortality for cystectomy for bladder cancer. Urology. 2007: 69:871–75.CrossRefGoogle Scholar
  3. 3.
    Novotny V, Hakenberg OW, Wiessner D (2007) et al. Perioperative complications of radical cystectomy in a contemporary series. Eur Urol. : 51:397–401.CrossRefGoogle Scholar
  4. 4.
    Roghmann F, Sukumar S, Ravi P, et al. Radical cystectomy in the elderly: national trends and disparities in perioperative outcomes and quality of care. Urol Int. 2014: 92:27–34.CrossRefGoogle Scholar
  5. 5.
    Taylor JM, Feifer A, Savage CJ, et al. Evaluating the utility of a preoperative nomogram for predicting 90-day mortality following radical cystectomy for bladder cancer. BJU Int. 2012:109:855–859.CrossRefGoogle Scholar
  6. 6.
    Froehner M, Brausi MA, Herr HW, Muto G, Studer UE. Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol. 2009: 56:443–54.CrossRefGoogle Scholar
  7. 7.
    Horovitz D, Turker P, Bostrom PJ, et al. Does patient age affect survival after radical cystectomy?. BJU Int. 2012:110:E486–93.CrossRefGoogle Scholar
  8. 8.
    Hautmann RE, Abol-Enein H, Davidsson T, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol. 2013:63:67–80.CrossRefGoogle Scholar
  9. 9.
    Lee RK, Abol-Enein H, Artibani W, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014:113:11–23.CrossRefGoogle Scholar
  10. 10.
    Gacci M, Saleh O, Cai T, et al. Quality of life in women undergoing urinary diversion for bladder cancer: results of a multicenter study among long-term disease-free survivors. Health Qual Life Outcomes. 2013:11:43.CrossRefGoogle Scholar
  11. 11.
    Kassouf W, Hautmann RE, Bochner BH, et al. A critical analysis of orthotopic bladder substitutes in adult patients with bladder cancer: is there a perfect solution? Eur Urol. 2010:58:374–83.CrossRefGoogle Scholar
  12. 12.
    Bianchi M, Trinh QD, Sun M, et al. Impact of academic affiliation on radical cystectomy outcomes in North America: a population-based study. Can Urol Assoc J. 2012:6:245–50.CrossRefGoogle Scholar
  13. 13.
    Goossens-Laan CA, Gooiker GA, van Gijn W, et al. A systematic review and meta-analysis of the relationship between hospital/surgeon volume and outcome for radical cystectomy: an update for the ongoing debate. Eur Urol. 2011:59:775–83.CrossRefGoogle Scholar
  14. 14.
    Kim SP, Boorjian SA, Shah ND, et al. Contemporary trends of in-hospital complications and mortality for radical cystectomy. BJU Int. 2012:110:1163–1168.CrossRefGoogle Scholar
  15. 15.
    Gore JL, Litwin MS. Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol. 2009:27:45–50.CrossRefGoogle Scholar
  16. 16.
    Kim SP, Shah ND, Weight CJ, et al. Population-based trends in urinary diversion among patients undergoing radical cystectomy for bladder cancer. BJU Int. 2013:112:478–84.CrossRefGoogle Scholar
  17. 17.
    Roghmann F, Becker A, Trinh QD, et al. Updated assessment of neobladder utilization and morbidity according to urinary diversion after radical cystectomy: A contemporary US-population-based cohort. Can Urol Assoc J. 2013:7:E552–60.CrossRefGoogle Scholar
  18. 18.
    Ridic G, Gleason S, Ridic O. Comparisons of health care systems in the United States, Germany and Canada. Mater Sociomed. 2012:24:112–20.CrossRefGoogle Scholar
  19. 19.
    Brown ET, Osborn D, Mock S, et al. Temporal Trends in Conduit Urinary Diversion With Concomitant Cystectomy for Benign Indications: A Population-based Analysis. Urology. 2016:98:70–74.CrossRefGoogle Scholar
  20. 20.
    Gore JL, Yu HY, Setodji C, Hanley JM, Litwin MS, Saigal CS. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer. 2010:116:331–39.CrossRefGoogle Scholar
  21. 21.
    Groeben C, Koch R, Baunacke M, Wirth MP, Huber J. Robots drive the German radical prostatectomy market: a total population analysis from 2006 to 2013. Prostate Cancer Prostatic Dis. 2016:19:412–16.CrossRefGoogle Scholar
  22. 22.
    Groeben C, Koch R, Baunacke M, Wirth MP, Huber J. High volume is the key for improving in-hospital outcomes after radical prostatectomy: a total population analysis in Germany from 2006 to 2013. World J Urol. 2017:35:1045–1053.CrossRefGoogle Scholar
  23. 23.
    HCUP nationwide inpatient sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2012. www.hcup-us.ahrq.gov/nisoverview.jsp.
  24. 24.
    Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015:12:e1001885.CrossRefGoogle Scholar
  25. 25.
    Abdollah F, Sun M, Schmitges J, et al. Surgical caseload is an important determinant of continent urinary diversion rate at radical cystectomy: a population-based study. Ann Surg Oncol. 2011:18:2680–687.CrossRefGoogle Scholar
  26. 26.
    Waingankar N, Mallin K, Smaldone M, et al. Assessing the relative influence of hospital and surgeon volume on short-term mortality after radical cystectomy. BJU Int. 2017:120:239–245.CrossRefGoogle Scholar
  27. 27.
    Leow JJ, Cole AP, Seisen T, et al. Variations in the costs of radical cystectomy for bladder cancer in the USA. Eur Urol. 17:30640-1.Google Scholar
  28. 28.
    Minnillo BJ, Maurice MJ, Schiltz N, et al. Few modifiable factors predict readmission following radical cystectomy. Can Urol Assoc J. 2015:9:E439–46.CrossRefGoogle Scholar
  29. 29.
    Williams SB, Huo J, Chamie K, et al. Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer. Eur Urol Focus. 2017:3:258–64.CrossRefGoogle Scholar
  30. 30.
    Hager B, Kraywinkel K, Keck B, et al. Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: A comparison of treatment trends in the United States and Germany from 2004 to 2011. Radiother Oncol. 2015:115:90–5.CrossRefGoogle Scholar
  31. 31.
    Groeben C, Koch R, Baunacke M, Wirth MP, Huber J. A total population analysis of in-hospital outcomes of radical cystectomy in Germany from 2006 to 2014: impact of surgical approach and annual caseload volume. J Urol (Suppl) 2017:197:e725.CrossRefGoogle Scholar
  32. 32.
    Nielsen ME, Mallin K, Weaver MA, et al. Association of hospital volume with conditional 90-day mortality after cystectomy: an analysis of the National Cancer Data Base. BJU Int. 2014:114:46–55.CrossRefGoogle Scholar
  33. 33.
    Roghmann F, Trinh QD, Braun K, et al. Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol. 2014:21:143–149.CrossRefGoogle Scholar
  34. 34.
    Squires D, Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. Issue Brief (Commonw Fund). 2015:15:1–15.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Christer Groeben
    • 1
  • Rainer Koch
    • 2
  • Martin Baunacke
    • 1
  • Marianne Schmid
    • 3
  • Angelika Borkowetz
    • 1
  • Manfred P. Wirth
    • 1
  • Johannes Huber
    • 1
  1. 1.Department of Urology, Medical Faculty Carl Gustav CarusTechnical University of DresdenDresdenGermany
  2. 2.Department of Medical Statistics and Biometry, Medical Faculty Carl Gustav CarusTU DresdenDresdenGermany
  3. 3.Department of UrologyUniversity Hospital GoettingenGoettingenGermany

Personalised recommendations