Role of Surgeon Volume in Radical Prostatectomy Outcomes

• DOI: 10.1200/jco.2003.05.169
• Publication Date: 2003-01-30T21:34:31Z
• Authors: Jim C. Hu; Karen F. Gold; Chris L. Pashos; Shilpa S. Mehta; Mark S. Litwin
• Keywords: Aged, 80 and over; Male; Prostatectomy; Anastomosis, Surgical; Prostatic Neoplasms; Length of Stay; Medicare; Prognosis; Hospitals; 3. Good health; 03 medical and health sciences; Postoperative Complications; Professional Competence; 0302 clinical medicine; Outcome Assessment, Health Care; Humans; Practice Patterns, Physicians'; Aged

To examine the effect of hospital and surgeon volume on postoperative outcomes to determine whether or is stronger predictor.Using 1997 1998 claims data from a national 5% random sample Medicare beneficiaries, we identified 2,292 men who underwent radical prostatectomy at 1,210 hospitals by 1,788 surgeons. Hospitals were classified as high (> = 60 per year) low (< according experience over 2-year period. Surgeons 40 volume. Multivariate logistic regression was performed control for patient demographics comorbidities when assessing association with in-hospital complications, length stay, anastomotic stricture rates. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, miscellaneous surgical medical conditions.High-volume surgeons had half complication risk (odds ratio [OR] 0.53; 95% confidence interval [CI], 0.32 0.89) shorter lengths stay (4.1 v 5.2 days, P =.03) compared low-volume High-volume patients tended have fewer strictures (OR 0.72; CI, 0.49 1.04). Patient age 75 years) associated more 1.9; 1.39 2.70), 2.2; 1.54 3.15), longer stays (parameter estimate 2.26; 1.75 2.77).Surgeon inversely related in undergoing prostatectomy. Hospital not significantly after adjusting physician Further study necessary elucidate mechanism volume-outcome effect.