title: The impact of surgical experience on total hospital charges for minimally invasive prostatectomy: a population-based study.
abstract: OBJECTIVE
  • To evaluate the relationship between surgical volume (SV) and total hospital charges in patients undergoing minimally invasive radical prostatectomy (MIRP) for treatment of localized prostate cancer.
  
  
  METHODS
  • Within the Florida Hospital Inpatient Datafile, 2666 men who were treated with MIRP for prostate cancer between 2002-2008 were identified. • The SV was defined in two ways: annual caseload (AC) and each surgeons experience (SE) defined as the total number of procedures performed since entering the study until the time of each MIRP.
  
  
  RESULTS
  • The mean and median charges were respectively 38,852 and 31,511 US Dollars. AC ranged from 1-171 and SE varied from 1-500. Overall, 75.7 to 94% of surgeons were in the lowest AC tertile and 27 to 66% of patients were operated by low AC tertile surgeons. • After stratification according to AC tertiles, median charges were 41,564; 33,395 and 26,608 US Dollar for respectively low intermediate and high AC tertile categories. • Multivariable logistic regression models with generalized estimating equations revealed that the probability of charges above the median was reduced by respectively 38 and 68% in patients operated by intermediate SE (17-76 MIRPs) or high SE tertile (≥ 77 MIRPs) surgeons vs. low SE tertile (≤ 16 MIRPs) surgeons.
  
  
  CONCLUSIONS
  • High surgical experience reduces MIRP total hospital charges. • Despite this observation, even in 2008, 82% of MIRP surgeons were in the lowest AC tertile and contributed to 32% of all MIRPs.
authors.affiliation: Martiniclinic, Prostate Cancer Center University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Budäus
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Rupinder
authors.initials: R
authors.lastname: Johal
authors.forename: Monica
authors.initials: M
authors.lastname: Morgan
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000191:economics* / Q000592:standards; D005431:Florida; D017722:Hospital Charges; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D011468:Prostatectomy / Q000191:economics* / Q000379:methods / Q000592:standards; D011471:Prostatic Neoplasms / Q000191:economics / Q000601:surgery*; D014572:Urology / Q000191:economics / Q000592:standards*; D016526:Workload / Q000191:economics