title: Impact of annual surgical volume on length of stay in patients undergoing minimally invasive prostatectomy: a population-based study.
abstract: BACKGROUND
  On average, patients remain hospitalized no more than 2 days after MIRP. The aim of our study was to examine the temporal trends in length of stay ≥ 3 days and to test the relationship between annual surgical volume (ASV) and annual hospital volume (AHV) and length of stay ≥ 3 days in patients undergoing MIRP.
  
  
  METHODS
  Within the Florida Hospital Inpatient Datafile, 2439 men who were treated with MIRP for prostate cancer between 2005 and 2008 were identified. Temporal trends were assessed and uni and multi-variable logistic regression models tested the relationship between ASV, AHV and length of stay ≥ 3 days.
  
  
  RESULTS
  The average length of stay decreased from 2.4 in 2005 to 1.7 days in 2008. Length of stay ≥ 3 days was recorded in 13.6% of patients and the proportion of patients staying more than ≥ 3 days decreased over time (25.5-12.2%; Chi Square trend p < 0.001). After stratification into low (<1-15 MIRPs) vs. intermediate (16-63 MIRPs) vs. high ASV tertiles (≥ 64 MIRPs) the proportion of patients with length of stay ≥ 3 days were 29.1; 13.2 and 11.1%. In multivariable logistic regression models predicting length of stay ≥ 3 days, ASV, year of surgery and comorbidities achieved independent predictor status and MIRP patients operated by highest ASV tertile surgeons were 71% (p < 0.001) less likely to be hospitalized for more than 3 days.
  
  
  CONCLUSIONS
  The length of stay after MIRP decreased between 2005 and 2008. Surgical expertise represented one of the main determinants of shorter length of stay.
authors.affiliation: Martiniclinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Budäus
authors.forename: M
authors.initials: M
authors.lastname: Morgan
authors.forename: F
authors.initials: F
authors.lastname: Abdollah
authors.forename: K C
authors.initials: KC
authors.lastname: Zorn
authors.forename: M
authors.initials: M
authors.lastname: Sun
authors.forename: R
authors.initials: R
authors.lastname: Johal
authors.forename: R
authors.initials: R
authors.lastname: Thuret
authors.forename: A
authors.initials: A
authors.lastname: Abdo
authors.forename: J
authors.initials: J
authors.lastname: Schmitges
authors.forename: H
authors.initials: H
authors.lastname: Isbarn
authors.forename: C
authors.initials: C
authors.lastname: Jeldres
authors.forename: P
authors.initials: P
authors.lastname: Perrotte
authors.forename: M
authors.initials: M
authors.lastname: Graefen
authors.forename: P I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D005431:Florida; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome