Impact of Anaesthetist Volume on Radical Cystectomy Outcomes.
Bladder cancer
Enhanced recovery after surgery
Radical cystectomy
Urothelial cancer
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
11
02
2019
revised:
30
03
2019
accepted:
24
04
2019
pubmed:
11
5
2019
medline:
26
3
2022
entrez:
11
5
2019
Statut:
ppublish
Résumé
Radical cystectomy (RC) is a gold standard treatment for aggressive bladder cancer. Higher surgical volumes through centralisation are associated with improved RC outcomes. The impact of anaesthetist experience and RC volume on outcomes is less clear. We sought to examine RC outcomes stratified by anaesthetist volume using a contemporary homogenous series. A retrospective analysis of a prospectively collected, single-surgeon database of RC patients over a 10-yr period. Four hundred and fifty-three consecutive patients underwent RC, including 430 (95%) with anaesthetist annotation. Anaesthetists were stratified into low- (<10 cases) and high-volume (≥10 cases) classes. Primary outcomes were blood loss, transfusion rates, length of stay (LOS), and postoperative mortality. In total, 63 anaesthetists were included for analysis (median two RCs per anaesthetist). Of 63 anaesthetists, 56 (88.9%) and seven (11.1%) were classified, respectively, into low and high volume, and these provided cover for 110 (25.6%) and 320 (74.4%) patients, respectively. When comparing high- versus low-volume anaesthetists, there were shorter LOS (median [interquartile range {IQR}]: 10 [6-14] vs 12 [7-19] d, p = 0.008), lower blood loss (median [IQR]: 600 [384-1000] vs 800 [500-1275] ml, p<0.001), and lower transfusion rate (23/320, 7.2% vs 22/110, 20%; p < 0.001). There was no difference in disease-specific mortality, overall mortality, or readmission rates. In multivariable analysis, a high anaesthetist volume was independently associated with transfusion rate (odds ratio 0.24 [0.07-0.83], p = 0.02). Higher-volume anaesthetists have lower transfusion rates for RC patients. Whilst LOS and blood loss may also differ with experience, there is no difference in mortality after RC. Radical cystectomy is a major operation. Experienced anaesthetists give fewer blood products to patients undergoing this operation. They may also help reduce blood loss and speed recovery. However, all other recovery measures were similar.
Sections du résumé
BACKGROUND
Radical cystectomy (RC) is a gold standard treatment for aggressive bladder cancer. Higher surgical volumes through centralisation are associated with improved RC outcomes. The impact of anaesthetist experience and RC volume on outcomes is less clear.
OBJECTIVE
We sought to examine RC outcomes stratified by anaesthetist volume using a contemporary homogenous series.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective analysis of a prospectively collected, single-surgeon database of RC patients over a 10-yr period.
INTERVENTION
Four hundred and fifty-three consecutive patients underwent RC, including 430 (95%) with anaesthetist annotation.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Anaesthetists were stratified into low- (<10 cases) and high-volume (≥10 cases) classes. Primary outcomes were blood loss, transfusion rates, length of stay (LOS), and postoperative mortality.
RESULTS AND LIMITATIONS
In total, 63 anaesthetists were included for analysis (median two RCs per anaesthetist). Of 63 anaesthetists, 56 (88.9%) and seven (11.1%) were classified, respectively, into low and high volume, and these provided cover for 110 (25.6%) and 320 (74.4%) patients, respectively. When comparing high- versus low-volume anaesthetists, there were shorter LOS (median [interquartile range {IQR}]: 10 [6-14] vs 12 [7-19] d, p = 0.008), lower blood loss (median [IQR]: 600 [384-1000] vs 800 [500-1275] ml, p<0.001), and lower transfusion rate (23/320, 7.2% vs 22/110, 20%; p < 0.001). There was no difference in disease-specific mortality, overall mortality, or readmission rates. In multivariable analysis, a high anaesthetist volume was independently associated with transfusion rate (odds ratio 0.24 [0.07-0.83], p = 0.02).
CONCLUSIONS
Higher-volume anaesthetists have lower transfusion rates for RC patients. Whilst LOS and blood loss may also differ with experience, there is no difference in mortality after RC.
PATIENT SUMMARY
Radical cystectomy is a major operation. Experienced anaesthetists give fewer blood products to patients undergoing this operation. They may also help reduce blood loss and speed recovery. However, all other recovery measures were similar.
Identifiants
pubmed: 31072807
pii: S2405-4569(19)30129-4
doi: 10.1016/j.euf.2019.04.013
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
117-123Informations de copyright
Copyright © 2019. Published by Elsevier B.V.