Bellaar Spruyt, J.A. (2012) Retrospectieve kwaliteitsanalyse van de radicale cystectomieën bij patiënten met een blaascarcinoom. thesis, Medicine.
Full text available on request.Abstract
Introduction: Bladder cancer is the most common malignancy in the urogenital tract. When muscle invasive bladder cancer is diagnosed, radical cystectomy provides the best chance to recover. Because of new operation techniques the perioperative mortality in recent years is reduced strongly. However, morbidity scores are still high. Between hospitals morbidity percentages vary largely. Possibly, these differences can be explained because of variations in procedural quality and clinical practice. In this study, the quality of the radical cystectomy is evaluated with regard to the HAGA and MCH hospitals. The purpose of this study is to analyze the quality of current practice in comparison with the current literature and to identify opportunities to improve the quality of the radical cystectomy in both hospitals. Materials and methods: In total 139 patients have been included of whom 86 were treated in the HAGA hospital and 53 in the MCH hospital. All patients have had a radical cystectomy to treat bladder cancer. The research population in the HAGA hospital includes patients between January 2005 and 30th of June 2011. In the MCH hospital patients were included in the period January 2005 untill 30th of September 2011. In retrospective, patient files were analyzed and a database with different quality indicators has been created. Consequently, the results have been compared between the two hospitals en the literature. The statistical analysis is performed with SPSS 19.0 Chigaco Inc, IBM. Results: The mortality rate in the HAGA hospital is 3,5% and in the MCH hospital 1,9%. 46% Of the patients have developed early complications. 23% Of the complications were minor ones and in 23% of the cases there have been at least one major complication. Wound dehiscence is the most common early complication (15,1%) and cause of re-surgery. The average hospital stay is 20,9 days. Late complications occurred in 42,4% of the population. The MCH hospital needs significantly less time to perform a cystectomy with significant less blood loss and a significantly lower probability of receiving blood transfusion. After correction, 68,9% of the patients in the HAGA hospital had the same clinical as pathological stage. This difference was significant compared to the 49,9% of the MCH hospital. Discussion and conclusion: The percentage of mortality in the first 30 days after surgery is seen as the most important qualitative indicator of the quality of the radical cystectomy. Moreover, complications, blood loss, procedure time, re-admittance rate and re-operation rate provide additional information regarding the quality of the procedure. Due to a lack of standardized methods to record complications, it is not always possible to draw conclusions on every quality indicator. Concludingly, the main areas of improvement are the reduction rate of wound dehiscence and the performance of at least a standard lymphadenectomy. Besides the high rate of wound dehiscence, which is associated with the high re-operation rate, the quality of care of the HAGA Hospital and the MCH hospital are comparable with current literature.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Nijholt, dr. I.M. junior affiliatie coördinator |
| Supervisor name: | Extern begeleider: and Kiewiet de Jonge, dr. Uroloog |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/583 |
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