Role of surgeon volume in radical prostatectomy outcomes.
OBJECTIVE
To examine the effect of hospital and surgeon volume on postoperative outcomes and to determine whether hospital or surgeon volume is the stronger predictor.


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 (> or = 60 per year) or low (< 60 per year) volume according to radical prostatectomy experience over the 2-year period. Surgeons were classified as high (> or = 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 (> or = 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).


CONCLUSIONS
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.
Hu
Jim C
JC
Departments of Urology and Health Services, University of California, Los Angeles David Geffen School of Medicine and School of Public Health, Los Angeles, CA 90095-1738, USA.
Gold
Karen F
KF
Pashos
Chris L
CL
Mehta
Shilpa S
SS
Litwin
Mark S
MS
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects* / Q000592:standards; D011471:Prostatic Neoplasms / Q000601:surgery*