Journal of Clinical Oncology, Vol 21, Issue 3
(February), 2003: 401-405
© 2003 American Society for Clinical Oncology
Role of Surgeon Volume in Radical Prostatectomy Outcomes
Jim C. Hu,
Karen F. Gold,
Chris L. Pashos,
Shilpa S. Mehta,
Mark S. Litwin
From the Departments of Urology and Health Services, University of California, Los Angeles David Geffen School of Medicine and School of Public Health, Los Angeles, CA; Abt Associates Clinical Trials, Bethesda, MD; and TAP Pharmaceutical Products Inc., Lake Forest, IL.
Address reprint requests to Mark S. Litwin, MD, Department of Urology, UCLA School of Medicine, Box 951738, Los Angeles, CA 90095-1738; email: mlitwin{at}ucla.edu.
Purpose: To examine the effect of hospital and surgeon volume on postoperative outcomes and to determine whether hospital or surgeon volume is the stronger predictor.
Patients and Methods: Using 1997 to 1998 claims data from a national 5% random sample of 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) or low (< 60 per year) volume according to radical prostatectomy experience over the 2-year period. Surgeons were classified as high ( 40 per year) or low (< 40 per year) volume. Multivariate logistic regression was performed to control for patient demographics and comorbidities when assessing the association of hospital and surgeon volume with in-hospital complications, length of stay, and anastomotic stricture rates. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, and miscellaneous surgical and medical conditions.
Results: High-volume surgeons had half the complication risk (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.32 to 0.89) and shorter lengths of stay (4.1 v 5.2 days, P = .03) compared with low-volume surgeons. High-volume hospital patients tended to have fewer anastomotic strictures (OR = 0.72; 95% CI, 0.49 to 1.04). Patient age ( 75 years) was associated with more complications (OR = 1.9; 95% CI, 1.39 to 2.70), more anastomotic strictures (OR = 2.2; 95% CI, 1.54 to 3.15), and longer hospital stays (parameter estimate = 2.26; 95% CI, 1.75 to 2.77).
Conclusion: Surgeon volume is inversely related to in-hospital complications and length of stay in men undergoing radical prostatectomy. Hospital volume is not significantly associated with outcomes after adjusting for physician volume. Further study is necessary to elucidate the mechanism of the volume-outcome effect.
Supported by TAP Pharmaceutical Products, Inc.
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