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Título

ANALYSIS OF RADICAL PROSTATECTOMIES FOR THE TREATMENT OF PROSTATE CANCER PERFORMED BY THE PUBLIC HEALTH SERVICE IN SAO PAULO CITY BETWEEN 2008 AND 2018

Resumo

INTRODUCTION: Radical prostatectomy (RP) is one of the options for the treatment of localized prostate cancer (PCa), among radiotherapy and active surveillance. The outcomes of surgical treatment may vary according to the hospital analyzed, especially when comparing low volume to high volume centers.

OBJECTIVE: The objective of this study is to describe and compare outcomes of RPs performed by the public health service of Sao Paulo city between 2008 and 2018 according to hospital volumetry and stratified into academic and non-academic centers.

METHODS: Retrospective study using publicly available database of Sao Paulo health service. Outcomes analyzed were number of surgeries performed, length of hospital stay, intensive care unit (ICU) length of stay, in-hospital mortality rate and cost of hospitalization. The public hospitals of Sao Paulo city were divided into three subgroups according to surgical volume (tercile) and the results were compared among themselves. The same comparisons were made between academic (AC) and non-academic centers (NAC). Were considered AC those with Urology Residency Program.

RESULTS: A total of 11,259 RPs were performed in Sao Paulo city between 2008 and 2018. The division of hospitals according to volume was as follow: the low volume (LV) group consisted of 11 hospitals that performed between one and six RPs each during the analyzed period; the intermediate volume (IV) group consisted of 11 hospitals that performed between 11 and 255 RPs each; the high volume (HV) group consisted of 10 hospitals that performed between 291 and 3,078 RPs each. Mean length of hospital stay was 5.77 days in IV and 3.99 days in HV centers (p=0.017). There was no statistically significant difference regarding to ICU length of stay, in-hospital mortality rate and cost of hospitalization. The division in AC and NAC was as follow: there were 13 AC that performed between two and 3,078 RPs and 19 NAC that performed between one and 1,091 RPs during the analyzed period. There was no difference regarding to in-hospital mortality rate and the mean length of hospital stay was lower in academic centers (p=0.042).

CONCLUSION: Length of hospital stay of RPs performed in public services of Sao Paulo city varied according to hospital volumetry and if the patient was treated in academic centers or not. Hospitals with high volume of surgeries and academic centers had lower length of hospital stay compared to others.

Palavras Chave ( separado por ; )

PROSTATE CANCER; RADICAL PROSTATECTOMY; HEALTH SYSTEM.