National trends, perioperative outcomes and re-admission rates in 12625 radical cystectomies (open, laparoscopic and robotic) in England based on HES data
BAUS ePoster online library. Vasdev N. 11/10/20; 304118; P12-9
Mr. Nikhil Vasdev
Mr. Nikhil Vasdev
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National trends, perioperative outcomes and re-admission rates in 12625 radical cystectomies (open, laparoscopic and robotic) in England based on HES data

Tamhankar A1, Hampson A1, Adshead J1, Thurairaja R2, Kelly J3, Catto J4, Vasdev N1
1Lister Hospital, Stevenage, United Kingdom, 2Guys Hospital, London, United Kington, 3Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, United Kingdom, 4Academic Urology Unit, University of Sheffield, United Kingdom

Introduction:
We evaluate the data of 12625 Radical Cystectomies in England (Open, Robotic and Laparoscopic) with trends in the adaption of techniques and post-operative complications.

Methods:
This analysis utilised national Hospital Episode Statistics (HES) from NHS England.

Results:
There was a statistically significant increase (p <0.001) in the number of Robotic assisted radical cystectomies from 10.8% in 2013-2014 and 39.5% in 2018-19[Figure 1]. The average LOS reduced from 12.3 days to 10.8 days for RARC from 2013 to 2019 similarly the LOS reduced from 16.2 to 14.3 for ORC. The rate of sepsis (0-90 days) did rise from 5% to 14.5% between 2013-14 and 2017-18 for the entire cohort (p<0.001). Acute Renal Failure (ARF) increased over the years from 9.5 % to 17% (p< 0.001). The rate for fever, UTI, critical care activity and ARF were higher for ORC than RARC (p <0.001). The comparison of all episodes within 90 days for conduit versus non-conduit diversions showed significantly higher rates of sepsis, infections, UTI and fever in non-conduit group .Overall complications were significantly higher in non-conduit group throughout the duration except was year 2016-17 (p <0.001).The robotic approach has increased in last 5 years with nearly 40% of the cystectomies now being robotically in 2018-19 from the initial percentage of 10.8% in 2013-14

Conclusion:
This evaluation of the HES data from NHS England for 12,625 RC confirms an increase in the adoption of Robotic Cystectomy. Our data confirms the need to develop strategies with enhanced recovery protocols and post-operative close monitoring following Radical Cystectomy in order to reduce post-operative complications.
National trends, perioperative outcomes and re-admission rates in 12625 radical cystectomies (open, laparoscopic and robotic) in England based on HES data

Tamhankar A1, Hampson A1, Adshead J1, Thurairaja R2, Kelly J3, Catto J4, Vasdev N1
1Lister Hospital, Stevenage, United Kingdom, 2Guys Hospital, London, United Kington, 3Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, United Kingdom, 4Academic Urology Unit, University of Sheffield, United Kingdom

Introduction:
We evaluate the data of 12625 Radical Cystectomies in England (Open, Robotic and Laparoscopic) with trends in the adaption of techniques and post-operative complications.

Methods:
This analysis utilised national Hospital Episode Statistics (HES) from NHS England.

Results:
There was a statistically significant increase (p <0.001) in the number of Robotic assisted radical cystectomies from 10.8% in 2013-2014 and 39.5% in 2018-19[Figure 1]. The average LOS reduced from 12.3 days to 10.8 days for RARC from 2013 to 2019 similarly the LOS reduced from 16.2 to 14.3 for ORC. The rate of sepsis (0-90 days) did rise from 5% to 14.5% between 2013-14 and 2017-18 for the entire cohort (p<0.001). Acute Renal Failure (ARF) increased over the years from 9.5 % to 17% (p< 0.001). The rate for fever, UTI, critical care activity and ARF were higher for ORC than RARC (p <0.001). The comparison of all episodes within 90 days for conduit versus non-conduit diversions showed significantly higher rates of sepsis, infections, UTI and fever in non-conduit group .Overall complications were significantly higher in non-conduit group throughout the duration except was year 2016-17 (p <0.001).The robotic approach has increased in last 5 years with nearly 40% of the cystectomies now being robotically in 2018-19 from the initial percentage of 10.8% in 2013-14

Conclusion:
This evaluation of the HES data from NHS England for 12,625 RC confirms an increase in the adoption of Robotic Cystectomy. Our data confirms the need to develop strategies with enhanced recovery protocols and post-operative close monitoring following Radical Cystectomy in order to reduce post-operative complications.
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