Cystectomy for bladder cancer in Sweden – short-term outcomes after centralization

Authors

  • Fredrik Liedberg Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Oskar Hagberg Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Firas Aljabery Department of Clinical and Experimental Medicine, Division of Urology, Linköping, University, Linköping, Sweden
  • Ove Andrén Section of Urology, Department of Surgery, Skellefteå Hospital, Sweden
  • Victor Falini Regional Cancercenter South, Lund, Sweden
  • Truls Gårdmark Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
  • Viveka Ströck Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
  • Tomas Jerlström Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

DOI:

https://doi.org/10.2340/sju.v59.40120

Keywords:

bladder cancer, radical cystectomy, centralization, hospital volume

Abstract

Objective: Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC has decreased in Sweden over time, and since a formal regional centralization in 2017 cystectomy care is currently provided by nine hospitals.

Material and methods: In the Swedish National Urinary Bladder Cancer Register (SNRUBC) 90-day complications after RC have been registered with high coverage since 2012. Descriptive data and short-term outcomes were compared in relation to centralization of the cystectomy care by stratifying data before (2012–2016) and after (2017–2023).

Results: Out of all 4,638 cystectomies, 2,738 (59%) were performed after the centralization in 2017 and onwards. The median age at RC increased from 71 (Inter Quartile Range [IQR] 65–76) to 73 (IQR 67–77) years, and the proportion of patients with comorbidity (American Society of Anesthesiologists [ASA] 3 or 4) increased from 32% to 37% after the centralization (p < 0.001). The number of patients suffering from high-grade complications within 90 days of surgery corresponding to Clavien grade three were 345 (18%) and 407 (15%), and corresponding to Clavien grade four 61 (3%) and 64 (2%) before and after centralization, respectively. Reoperations within 90 days of RC decreased from 234/1,900 (12%) to 208/2,738 (8%) (p < 0.001), and 90-day mortality decreased from 84/1,900 (4%) to 85/2,738 (3%) (p = 0.023) before and after centralization, respectively.

Conclusion: After the centralization of the cystectomy-care in Sweden, older patients and individuals with more extensive comorbidity were offered RC whereas 90-day mortality and the proportion of patients subjected to reoperations within 90 days of surgery decreased without increasing waiting times.

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Published

2024-04-29

How to Cite

Liedberg, F., Hagberg, O., Aljabery, F., Andrén, O., Falini, V., Gårdmark, T., … Jerlström, T. (2024). Cystectomy for bladder cancer in Sweden – short-term outcomes after centralization. Scandinavian Journal of Urology, 59, 84–89. https://doi.org/10.2340/sju.v59.40120

Issue

Vol. 59 (2024)

Section

Original research article

License

Copyright (c) 2024 Fredrik Liedberg, Oskar Hagberg, Firas Aljabery, Ove Andrén, Victor Falini, Truls Gårdmark, Viveka Ströck, Tomas Jerlström

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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