INTRODUCTION: The treatment of bladder cancer has been centralised in Denmark, and only five departments are licensed to perform radical cystectomy (RC). The purpose of this nationwide study was to evaluate perioperative mortality, length of post-operative hospital stay (LOS) and readmissions related to time course, surgical technique and number of RCs performed.

METHODS: Patients were identified from the Danish National Hospital Register. We included all patients who had a RC performed because of bladder cancer in the period 2006-2013.

RESULTS: A total of 1,857 RCs were performed, 81% of which were open and 19% were robot-assisted operations. Median LOS ranged 8-15 days, with the minimum LOS at the end of period. Readmission within 30 days occurred in 35% of patients. For patients operated with open technique, the readmission rate was 32% versus 45% for robot-assisted surgery. The 30-day mortality was 1.3% of which 1.5% occurred after open and 0.6% after robot-assisted RC.

CONCLUSIONS: The study shows an increase in the number of RCs performed and a decrease in LOS during the study period. Furthermore, the study reveals a significant uptake of robot-assisted RC without obvious demonstrable benefits in terms of LOS and readmissions, but with a slightly lower mortality. Selection criteria for robot-assisted RC as well as data on tumour stage and preoperative co-morbidities are not available; therefore, interdepartmental comparison is not possible. However, these nationwide data suggest room for improvement through integration of the fast-track methodology combined with optimisation of surgical technique.

FUNDING: none.

TRIAL REGISTRATION: not relevant.