BERKELEY, CA (UroToday Inc.) - Bladder cancer is known to be one of the most expensive cancers in terms of healthcare expense from the time of diagnosis to death. In 2001, the estimated cost of the over 7,100 radical cystectomies performed in the United States was $54,153 per patient. The average length of hospital stay was approximately 14 days with the incidence of post-operative complications being 29%, even at institutions that perform a large number of procedures.

Given the increased emphasis on cost containment and efficiency, as well as the desire to reduce the incidence of post-operative complications, A. T Ludwig and colleagues from the University of Iowa, have been performing some radical cystectomies with urinary diversion (C & D) using a two-team approach. The second surgeon performed the diversion portion of the procedure after the first surgeon had completed the cystectomy. In a retrospective study published in the Month, 2005 issue of Urology, they compared the procedure related charges, hospital charges, operating room time, length of stay and complication rate between a group of patients undergoing C & D with either a two-surgeon or a single-surgeon approach.

They retrospectively analyzed a total of 63 patients with bladder cancer who underwent C & D. Two surgeons sequentially performed the cystectomy with ileal conduit (IC, n = 17) or neobladder (NBL, n = 18), or a single surgeon performed both the cystectomy and IC (n = 21) or NBL (n = 7).

Analysis revealed that the two-surgeon team had significantly greater surgeon charges but significantly lower anesthesia charges for their two types of urinary diversion. The single surgeon procedures resulted in 60% and 32% lower surgeon charges respectively for IC or NBL, but respectively 23% and 22% greater anesthesia charges for the ileal conduit or NBL. Overall, no significant difference in charges was noted for the IC group, while for the neobladder group, the reduced anesthesia and OR time did not completely offset the increased total physician charges. Interestingly, overall hospital charges were about equal for both approaches to C & D.

A close look at the operative durations showed that the median operative minutes for the ileal conduit cases by the single surgeon was 488 versus 379 for the two-surgeon team. For the neobladder cases, the surgical minutes for the single-surgeon cases were 574 versus 424 for the two-surgeon team. Therefore, for two surgeons there was an average reduction in surgical duration of 22% for the ileal conduit cases and 26% for the neobladder cases. No significant differences were seen in complication rates between the two groups with complication rates equal at around 29%.

In conclusion, this study shows that a two-team approach to radical cystectomy did not compromise outcomes and has the potential to reduce costs secondary to decreased operating room duration.

Urology. 2005 Month; 65(3):488-492