Academic Urology Unit, University of Sheffield, Sheffield, UK.
Department of Anaesthetics, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Eur Urol Focus. 2021 Jan;7(1):117-123. doi: 10.1016/j.euf.2019.04.013. Epub 2019 May 6.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
根治性膀胱切除术（RC）是治疗侵袭性膀胱癌的金标准。通过集中化提高手术量与 RC 结果的改善相关。麻醉师经验和 RC 量对结果的影响尚不清楚。
我们试图使用当代同质系列来检查按麻醉师量分层的 RC 结果。
设计、地点和参与者：对一位外科医生在 10 年内前瞻性收集的 RC 患者数据库进行回顾性分析。
453 例连续患者接受 RC，其中 430 例（95%）有麻醉师注释。
将麻醉师分为低量（<10 例）和高量（≥10 例）。主要结局是失血量、输血率、住院时间（LOS）和术后死亡率。
共有 63 名麻醉师参与分析（中位数每位麻醉师进行 2 次 RC）。在 63 名麻醉师中，分别有 56 名（88.9%）和 7 名（11.1%）被归类为低量和高量，他们分别为 110 名（25.6%）和 320 名（74.4%）患者提供了服务。当比较高量与低量麻醉师时，低量麻醉师的 LOS 更短（中位数[四分位距{IQR}]{IQR}：10[6-14] vs 12[7-19]d，p=0.008），失血量更少（中位数[IQR]：600[384-1000] vs 800[500-1275]ml，p<0.001），输血率更低（23/320，7.2% vs 22/110，20%；p<0.001）。疾病特异性死亡率、总死亡率或再入院率无差异。多变量分析显示，高麻醉师量与输血率独立相关（比值比 0.24[0.07-0.83]，p=0.02）。
高量麻醉师为 RC 患者输血率较低。尽管经验也可能导致 LOS 和失血量的差异，但 RC 后死亡率无差异。
根治性膀胱切除术是一种大手术。经验丰富的麻醉师为接受该手术的患者提供较少的血液制品。他们还可能有助于减少失血并加速康复。然而，所有其他康复措施都相似。
