title: Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review.
abstract: OBJECTIVE
  We examined the association between hospital and surgeon volume, and patient outcomes after radical prostatectomy.
  
  
  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.
authors.affiliation: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota, USA. tim.wilt@med.va.gov
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: Tatyana A
authors.initials: TA
authors.lastname: Shamliyan
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
mesh_terms: D002983:Clinical Competence; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011468:Prostatectomy / Q000401:mortality / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*