Association Between Hospital and Surgeon Radical Prostatectomy Volume and Patient Outcomes: A Systematic Review

Timothy J. Wilt, Tatyana A. Shamliyan, Brent C. Taylor, Roderick MacDonald, Robert L. Kane

Research output: Contribution to journalArticlepeer-review

99 Scopus citations

Abstract

Purpose: We examined the association between hospital and surgeon volume, and patient outcomes after radical prostatectomy. Materials and Methods: Databases were searched from 1980 to November 2007 to identify controlled studies published in English. Information on study design, hospital and surgeon annual radical prostatectomy volume, hospital status and patient outcome rates were abstracted using a standardized protocol. Data were pooled with random effects models. Results: A total of 17 original investigations reported patient outcomes in categories of hospital and/or surgeon annual number of radical prostatectomies, and met inclusion criteria. Hospitals with volumes above the mean (43 radical prostatectomies per year) had lower surgery related mortality (rate of difference 0.62, 95% CI 0.47-0.81) and morbidity (rate difference -9.7%, 95% CI -15.8, -3.6). Teaching hospitals had an 18% (95% CI -26, -9) lower rate of surgery related complications. Surgeon volume was not significantly associated with surgery related mortality or positive surgical margins. However, the rate of late urinary complications was 2.4% lower (95% CI -5, -0.1) and the rate of long-term incontinence was 1.2% lower (95% CI -2.5, -0.1) for each 10 additional radical prostatectomies performed by the surgeon annually. Length of stay was lower, corresponding to surgeon volume. Conclusions: Higher provider volumes are associated with better outcomes after radical prostatectomy. Greater understanding of factors leading to this volume-outcome relationship, and the potential benefits and harms of increased regionalization is needed.

Original languageEnglish (US)
Pages (from-to)820-829
Number of pages10
JournalJournal of Urology
Volume180
Issue number3
DOIs
StatePublished - Sep 2008
Externally publishedYes

Keywords

  • outcome and process assessment (health care)
  • physician's practice patterns
  • professional competence
  • prostate
  • prostatectomy

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