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Título

SURGICAL BLADDER CANCER TREATMENT TRENDS IN THE PUBLIC HEALTH SYSTEM IN SAO PAULO – BRAZIL, BETWEEN 2008 AND 2019

Resumo

INTRODUCTION: Bladder cancer has a high prevalence and incidence worldwide. In Brazil, it corresponds to the ninth most common cancer diagnosis, and bladder cancer deaths represent about 2% of all cancer deaths. Transurethral resection of the bladder tumor (TURBT) and radical cystectomy (RC) remain the standard procedures for this disease's surgical management.

OBJECTIVE: The objective of this study is to describe and compare outcomes of TURBT and RC performed by the public health system between 2008 and 2019 in Sao Paulo city, according to hospital volumetry and stratified according to academic or non-academic centers.

METHODS: Retrospective study using data from a national health system database. We analyzed 2 procedures: TURBT and RC. For each procedure, public hospitals of Sao Paulo city were divided into 2 groups according to hospital volumetry (lower volume vs. higher volume) and again in 2 different groups for being academic centers or not. Centers were considered as academic when harboring a urology residency program recognized by Brazilian Urological Society. Outcomes analyzed included the number of surgeries performed, hospital length of stay, intensive care unit (ICU) length of stay, in-hospital mortality rate, and hospitalization cost.

RESULTS: A total of 13,126 TURBTs and 677 RCs were performed during the analyzed period. For RC, hospital length of stay was 12.91 days in the higher volume (HV) group compared to 13.16 days in the lower volume (LV) group (p=0.036). For TURBT, ICU length of stay was slightly lower in the HV group (p=0.017). For both TURBT and RC, the in-hospital mortality rate was higher in the HV group. Finally, the LV group had a higher cost of hospitalization for TURBT (p=0.005). Comparing academic centers to non-academic centers, there was no statistically significant difference considering all outcomes, except hospital length of stay that was lower in academic centers when analyzing TURBT (p=0.032).

CONCLUSION: Regarding hospital volumetry, HV centers tended to have better outcomes compared to LV ones, except when the in-hospital mortality rate was analyzed. In this case, HV hospitals had a higher mortality rate. Similar results were demonstrated when academic and non-academic centers were compared.

Palavras Chave ( separado por ; )

BLADDER CANCER; TRANSURETHRAL RESECTION OF BLADDER TUMOR; RADICAL CYSTECTOMY; HEALTH SYSTEM; COSTS.