title: Patient outcomes and length of hospital stay after radical prostatectomy for prostate cancer: analysis of hospital episodes statistics for England.
abstract: OBJECTIVE
  To investigate the morbidity and mortality after radical prostatectomy (RP) in relation to the numbers of RPs carried out at individual hospitals, as recent studies of complex surgery report worse outcomes in low-volume hospitals, and there has been a large increase in RPs for localized prostate cancer.
  
  
  METHODS
  We analysed hospital episode statistics data for all 18 027 RPs in English National Health Service hospitals between 1997 and 2004.
  
  
  RESULTS
  In multivariate analysis, there was a U-shaped association of hospital volume with mortality (P for nonlinear trend, 0.004), but this finding was based on only 59 (0.3%) deaths. The mean length of stay was 6 days and decreased by 2.96% (95% confidence interval, CI, 1.98-3.92; P < 0.001) per quintile increase in hospital volume. In all, 16.1% of men had 30-day in-hospital complications; 20.3% were readmitted with complications within a year. The odds of 30-day in-hospital wound/bleeding complications decreased by 6% (95% CI 1-11; P = 0.02), and miscellaneous medical complications decreased by 10% (0-19; P = 0.04) per increase in hospital volume quintile. For re-admissions within a year, the hazard of vascular complications decreased by 15% (6-22; P = 0.001), wound/bleeding complications decreased by 8% (2-13; P = 0.01) and genitourinary complications decreased by 5% (2-8; P = 0.002), per increase in hospital volume quintile.
  
  
  CONCLUSIONS
  In men undergoing RP the length of hospital stay and rates of some short- and long-term postoperative complications afterward are lower in high-volume hospitals. The magnitudes of these effects on the outcomes studied may be too small and inconsistent to indicate a policy of selective referral to high-volume hospitals. Quality of life and oncological outcomes, however, could not be investigated in this dataset.
authors.affiliation: MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK. andrew.judge@bristol.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Judge
authors.forename: Simon
authors.initials: S
authors.lastname: Evans
authors.forename: David J
authors.initials: DJ
authors.lastname: Gunnell
authors.forename: Peter C
authors.initials: PC
authors.lastname: Albertsen
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
mesh_terms: D000368:Aged; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000401:mortality* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery; D016896:Treatment Outcome