National centralization of bladder exstrophy epispadias complex (Beec) patients in Sweden: a comparison of short-term postoperative outcomes

Abstract Introduction The Swedish National Board of Health and Welfare centralized the surgical care of bladder exstrophy epispadias complex (BEEC) from four centers to one on 1 July 2018. The aim of this study was to assess short-term postoperative outcomes in BEEC patients following centralization. Method This retrospective observational study included all patients who underwent primary surgery for BEEC in Sweden from 1 July 2013 to 30 June 2023. Patients treated in the 5 year-period prior to centralization were compared with those treated during the 5 year-period after centralization. Main outcomes were unplanned readmissions, surgical procedures, and complications graded according to Clavien Madadi >3 within 90 postoperative days. Result Nineteen and 21 patients underwent primary surgery due to BEEC before and after centralization, respectively. Median age at first contact with a paediatric urologist and age at primary surgery was similar before and after centralization. Osteotomies were more common prior to centralization (92% vs 36%, p=0.01). Median length of hospital stay, epispadias patients excluded, was shorter after centralization (16 vs 26 days, p<0.001). Unplanned readmissions were required in 19 % (p=0.92) of patients both prior and after centralization and unplanned surgical procedures in 5% vs 10% (p=0.92) respectively. One complication grade IIIa occurred before centralization compared to two grade IIIa complications post centralization (p=0.92). Discussion Centralization of care for BEEC did not delay time to first visit with paediatric urologist or time to primary surgery. Unplanned readmission or surgical procedures did not increase after centralization. Performing osteotomies was less common post centralization, probably explaining shorter hospital stays.