The effect of minimally invasive and open radical prostatectomy surgeon volume.
OBJECTIVE
To determine the effect of minimally invasive radical prostatectomy (MIRP) surgeon volume on outcomes, and correlate with those of open radical prostatectomy retropubic (ORP).


METHODS
Observational population-based study of 8,831 men undergoing MIRP and ORP by 1,457 low, medium, and high volume surgeons from SEER-Medicare linked data from 2003 to 2007. After stratifying by surgeon ORP and MIRP volume, the following outcomes were studied: length of stay, transfusions, post-operative 30-day and anastomotic stricture complications, and use of additional cancer therapies.


RESULTS
Men undergoing MIRP with high and medium vs. low volume surgeons were less likely to require additional cancer therapies (4.5% and 4.7% vs. 7%, P = 0.020). Similarly, men undergoing ORP with high vs. medium and low volume surgeons were less likely to require additional cancer therapies (5.7% vs. 6.8% and 7.1%, P = 0.044). Men undergoing ORP with high vs. medium and low volume surgeons experienced shorter lengths of stay (2.9 vs. 3.3 and 3.6 days, P < 0.001), and fewer transfusions (15.4% vs. 21.3% and 22.7%, P = 0.017), 30-day complications (18.4% vs. 25.6% and 25.7%, P < 0.001), and anastomotic strictures (10.1% vs. 15.6% and 16.3%, P = 0.003). However, MIRP surgeon volume did not affect these outcomes.


CONCLUSIONS
Men undergoing MIRP or ORP with high volume surgeons were less likely to require additional cancer therapies. Additionally, patients of high volume ORP surgeons were more likely to experience shorter hospital stays, fewer transfusions, 30-day complications, and anastomotic strictures, while MIRP surgeon volume did not affect these peri-operative outcomes.
Choi
Wesley W
WW
Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
Gu
Xiangmei
X
Lipsitz
Stuart R
SR
D'Amico
Anthony V
AV
Williams
Stephen B
SB
Hu
Jim C
JC
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology