Impact of caseload on total hospital charges: a direct comparison between minimally invasive and open radical prostatectomy--a population based study.
OBJECTIVE
We tested the relationship between caseload and total hospital charges after stratifying by minimally invasive and open radical prostatectomy.


METHODS
We evaluated 1,188 vs 3,354 men treated with minimally invasive vs open radical prostatectomy in the Florida Hospital Inpatients data file in 2008. Caseload was defined as the count of procedures performed by each surgeon between the study start on January 1, 2008 and the date of each procedure. Patients were divided into tertiles based on their procedure specific caseload. Univariate and multivariate analysis was done to address the relation between caseload and total hospital charges for the minimally invasive and open procedures. Covariates were patient age, race, comorbidity, and length of stay.


RESULTS
Median total hospital charges for minimally invasive and open radical prostatectomy were $33,234 and $33,674, respectively (p=0.03). Median total hospital charges in the low, intermediate and high minimally invasive vs open procedure caseload tertiles were $41,765, $34,799 and $28,780 vs $35,642, $34,726 and $32,726, respectively. On multivariate analysis with the high minimally invasive caseload tertile as the reference category the increments of the probability of charges in excess of the 2008 median of $33,588 were 3.9 and 8.1-fold for the intermediate and low caseload minimally invasive procedures, and 2.5, 3.6 and 2.8-fold for the high, intermediate and low caseload open procedures, respectively (each p<0.001).


CONCLUSIONS
Overall median total hospital charges are virtually the same for minimally invasive and open radical prostatectomy. However, total hospital charges for the minimally invasive procedure have a more sensitive caseload effect, as evidenced by the wider distribution of the median of minimally invasive caseload specific total hospital charges vs that of open radical prostatectomy. The high caseload minimally invasive procedure resulted in the lowest total hospital charges relative to all other minimally invasive and open radical prostatectomy categories.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Firas
F
Abdollah
Lars
L
Budäus
Maxine
M
Sun
Monica
M
Morgan
Rupinder
R
Johal
Rodolphe
R
Thuret
Kevin C
KC
Zorn
Hendrik
H
Isbarn
Alexander
A
Haese
Claudio
C
Jeldres
Paul
P
Perrotte
Francesco
F
Montorsi
Markus
M
Graefen
Pierre I
PI
Karakiewicz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*