Influence of hospital and surgeon volumes on operative time, blood loss and perioperative complications in radical nephrectomy.
OBJECTIVE
We conducted a nationwide multi-center survey using medical record-based data to investigate the relationship between hospital/surgeon volumes and various outcomes, including operative time, volume of blood loss, and incidence of perioperative complications, in radical nephrectomy for renal cell carcinoma.


METHODS
We investigated a total of 1704 patients who underwent radical nephrectomy at 461 hospitals in Japan between November 2006 and February 2007. The association between hospital/surgeon volumes and operative time, volume of blood loss, and incidence of perioperative complications were independently analyzed using multivariate regression analysis against age, gender, operation site, cancer stage, serum creatinine levels, comorbid conditions, and surgical technique (open surgery or minimally invasive surgery).


RESULTS
Neither hospital volume nor surgeon volume was a significant predictor of operative time or volume of blood loss. We did not identify any association between hospital volume and perioperative complications. High-volume (> 100) surgeons were unlikely to have perioperative complications compared to low-volume (< 20) surgeons, but the relation was not significant (odds ratio, 0.50; 95% confidence intervals, 0.14-1.87; P = 0.30).


CONCLUSIONS
Volume-outcome relationships were not confirmed for radical nephrectomy. According to our study, the justification of regionalizing radical nephrectomy to centers of excellence is not yet clear.
Yasunaga
Hideo
H
Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. yasunagah-jyo@h.u-tokyo.ac.jp
Yanaihara
Hitoshi
H
Fuji
Kohzo
K
Matsuyama
Yutaka
Y
Deguchi
Nobuhiro
N
Ohe
Kazuhiko
K
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006276:Health Facility Size; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors