title: The effect of annual surgical caseload on the rates of in-hospital pneumonia and other in-hospital outcomes after radical prostatectomy.
abstract: OBJECTIVE
  To examine the effect of annual surgical caseload (ASC) on contemporary in-hospital pneumonia (IHP) rates and three other in-hospital outcomes after radical prostatectomy (RP).
  
  
  METHODS
  Between 1999 and 2008, 34,490 open RPs were performed in the state of Florida. First, logistic regression models predicting the rate of IHP were fitted. Second, other logistic regression models examined the association between IHP and three other outcomes: in-hospital mortality, hospital charges within the highest quartile, and length of stay (LOS) within the highest quartile. Covariates included ASC, age, race, baseline Charlson Comorbidity Index (CCI), interval between admission and surgery, as well as blood transfusion.
  
  
  RESULTS
  The overall IHP rate was 0.5%. It was higher in patients operated within the low (0.7%) and intermediate (0.5%) ASC tertile versus high ASC tertile (0.2%, P < 0.001). Mortality rate was 4.3% in IHP patients versus 0.1% in others (P < 0.001). Median total hospital charges and median LOS were $55,350 versus $28,171 and 7 versus 3 days in IHP patients versus others, respectively (both P < 0.001). In multivariable analyses predicting IHP, the likelihood was 3.2-fold in patients operated by low ASC surgeons versus high ASC surgeons (P < 0.001). Second, in multivariable analyses, IHP patients were predisposed to 41-fold higher in-hospital mortality, were tenfold more likely to have total hospital charges >$37,333, and were 20-fold more likely to have a LOS >3 days (all P < 0.001).
  
  
  CONCLUSIONS
  RP by high ASC surgeons exerts a protective effect on IHP rates. Additionally, IHP is associated with higher in-hospital mortality, prolonged LOS, and higher hospital charges.
authors.affiliation: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. janschmitges@gmx.de
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Ahyai
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005431:Florida / Q000453:epidemiology; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications; D011468:Prostatectomy / Q000706:statistics & numerical data*; D012307:Risk Factors