Trends in Operative Caseload and Mortality Rates after Radical Cystectomy for XXXX in England for 1998-2010.

@entity5 @entity1 @entity150
BACKGROUND: The Improving Outcomes in @entity5 guidelines recommended centralisation of cystectomy services to improve outcomes for @entity150 ( @entity150 ) @entity1 . OBJECTIVE: To investigate trends in all-cause and cause-specific survival to see if there was an improvement in survival after centralisation was implemented. To analyse trends in the number of acute hospital trusts undertaking cystectomy. DESIGN, SETTING, AND @entity1 : We used routine data to capture information on radical cystectomy (RC) in @entity150 @entity1 aged 20 yr and older between 1998 and 2010 (n=16  033). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We calculated 30-d and 90-d mortality, and 30-d, 90-d, 1-yr, and 5-yr survival. The average number of RCs per trust was derived. Trends were identified using regression analysis. RESULTS AND LIMITATIONS: The 30-d crude mortality decreased from 5.2% to 2.1% (p<0.001) and 90-d crude mortality decreased from 10.3% to 5.1% (p<0.001). There was an increase in 30-d relative survival from 96% to 98% (p<0.001), in 90-d relative survival from 91% to 96% (p<0.001), in 1-yr relative survival from 71% to 80% (p<0.001), and in 5-yr relative survival from 49% to 56% (2004-2006 data; p<0.001). The mean number of RCs performed by trusts in England increased from six to 24 (p<0.001). Smoking status and stage at diagnosis were not available. CONCLUSIONS: Survival after RC has increased alongside decreases in short-term mortality. There is little evidence of a cohort effect. The trends in survival are linear and we conclude that the continued survival improvements are a result of a combination of service improvements that include service reconfiguration, improved surgical training, neoadjuvant chemotherapy, enhanced recovery principles, and continued improvements in perioperative care. @entity1 SUMMARY: We analysed routinely collected hospital data. Outcomes for @entity1 who undergo cystectomy have improved for all age groups. This is likely to be due to a combination of changes in practice.
