Urologists in England performing nephrectomy for cancer are mandated in providing public-facing outcome data as part of the ‘Consultant Outcomes Publication’. The BAUS complex operations registry is a nationally held repository, providing contemporary benchmarking data to both patients and professionals.
The BAUS registry was retrospectively reviewed for cases between 2016 and 2018. For this analysis, all patients were from England, had a non-benign diagnosis and had their exact operation recorded. There are two opportunities for surgeons to review and amend their data before lockdown and data cleansing.
18,369 malignant nephrectomies were recorded during this period taking place across 145 centres by 272 surgeons. Using Hospital episode statistics (HES) as the comparator, the BAUS nephrectomy dataset for England (2016-18) was deemed to be 91.3% complete. Cases were be sub-divided into three categories: radical nephrectomy (RN) (58.3%), nephroureterectomy (NU) (16.1%) & partial nephrectomy (PN) (25.6%). Each was individually analysed focussing on patient demographics, presentation, intraoperative, postoperative, surgical volume & histological variables. Overall the median patient age was 66 with 64.1% of patients being male. Preoperative diagnosis was recorded as renal mass in 84.5% & upper tract transitional cell carcinoma in 15.5%. Overall, 74.4% of PN and 50.3% RN were performed for incidental findings, whilst 66.2% of patients undergoing a NU had presented symptomatically with haematuria. Pre-operative biopsies were performed in 7.1% of RN, 39.9% of NU & 17.3% of PN. Minimally invasive surgery (MIS) was undertaken in 80.0% of cases with robotically-assisted surgery being the predominant surgical approach in PN (62.2%). Conversion to open remained rare, with a rates ranging from 3.1% in RN to 2.1% in NU & 1.79% in PN. Transfusion rate was rare at 6.3% in RN, 3.4% in NU & 2.1% in PN. Between operations there was little variation in median length of stay with 3 days in RN & PN and 4 in NU. Clear cell renal carcinoma was the most commonly reported final histology in 77% of RN & 65% of PN. TCC accounted for 84% of NU cases. Benign final histology was 3.2% (RN), 3.7% (NU) & 13.4% (PN).
The BAUS nephrectomy dataset represents one of the largest, unselected case series capable of benchmarking surgical practice and outcomes at a national level. Individual surgeons can compare their case-mix, current surgical practice & selected outcomes with the national benchmarking comparators. With public-facing dissemination of these data, patients can also improve their knowledge of expected clinical outcomes. The data also offer an insight into changes in service provision nationally such as centralisation of surgery and adoption of novel surgical techniques.