Department of Urology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
Department of Medical Statistics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
Ann Surg Oncol. 2018 Nov;25(12):3502-3509. doi: 10.1245/s10434-018-6381-1. Epub 2018 Feb 21.
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.
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.
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).
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.
我们旨在评估和比较美国和德国接受根治性膀胱切除术治疗膀胱癌患者的尿流改道术（UD）趋势，并研究选择 UD 的决定性预测因素。
我们分析了 2006 年至 2014 年期间全国性德国医院计费数据库和全国住院患者样本（NIS）。纳入膀胱癌诊断合并 RC 的病例，并评估 UD 的选择、输血率、住院时间和死亡率的趋势。
2006 年至 2014 年，NIS 记录的 RC 总数为 17711 例，每年的病例数在 1666-2009 例之间变化，而德国的 RC 数量从 5627 例增加到 7390 例（趋势 p<0.001），共 60447 例。美国不可控性 UD 的比例保持稳定在 93%，而德国则从 63.2%增加到 70.8%。多变量模型表明，年龄和性别是两国选择 UD 的最重要因素，而医院病例数和教学地位在美国是不太相关的因素。与德国相比，美国的院内死亡率较低（1.9%比 4.6%；p<0.001），住院时间明显较短（美国 10.7 天，德国 25.1 天；p<0.001）。
近年来，患者年龄增长，合并症增加，导致德国不可控性 UD 的使用增加，而美国的可控性 UD 似乎使用不足。在美国，死亡率和输血率较低，住院时间较短。
