Low annual caseloads of United States surgeons conducting radical prostatectomy.
OBJECTIVE
It has been clearly demonstrated that surgeons with increased yearly caseloads have lower complication rates. Moreover it has been shown that a surgeon needs to conduct at least 250 radical prostatectomies to maximize cancer control (the surgical learning curve).


METHODS
To determine typical annual radical prostatectomy caseloads of surgeons in the United States we analyzed data from 2 independent data sets for 2005, that of a nationally representative sample (Nationwide Inpatient Sample) and a complete record of all hospital discharges from New York State (Statewide Planning and Research Cooperative System).


RESULTS
More than 25% of United States surgeons conducting radical prostatectomy in 2005 performed only a single procedure. Approximately 80% of surgeons performed fewer than 10 procedures per year and, thus, are unlikely to reach the plateau of the learning curve during their surgical career.


CONCLUSIONS
The current pattern of surgical treatment for prostate cancer leads to many patients being treated by surgeons with low annual caseloads, with likely poorer outcomes as a result.
Savage
Caroline J
CJ
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Vickers
Andrew J
AJ
D002983:Clinical Competence; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000592:standards* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*