title: Hospital volume is a determinant of postoperative complications, blood transfusion and length of stay after radical or partial nephrectomy.
abstract: OBJECTIVE
  We examined the impact of hospital volume on short-term outcomes after nephrectomy for nonmetastatic renal cell carcinoma.
  
  
  METHODS
  Using the Nationwide Inpatient Sample we identified 48,172 patients with nonmetastatic renal cell carcinoma treated with nephrectomy (1998 to 2007). Postoperative complications, blood transfusions, prolonged length of stay and in-hospital mortality were examined. Stratification was performed according to teaching status, nephrectomy type (partial vs radical nephrectomy) and surgical approach (open vs laparoscopic). Multivariable logistic regression models were fitted.
  
  
  RESULTS
  Patients treated at high volume centers were younger and healthier at nephrectomy. High hospital volume predicted lower blood transfusion rates (8.5% vs 9.7% vs 11.8%), postoperative complications (14.4% vs 16.6% vs 17.2%) and shorter length of stay (43.1% vs 49.8% vs 54.0%, all p <0.001). In multivariable analyses stratified according to teaching status, nephrectomy type and surgical approach, high hospital volume was an independent predictor of lower rates of postoperative complications (OR 0.73-0.88), blood transfusions (OR 0.71-0.78) and prolonged length of stay (OR 0.76-0.89, all p <0.001). Exceptions were postoperative complications at nonteaching centers (OR 0.94, p >0.05) and blood transfusions in nephrectomies performed laparoscopically (OR 0.68, p >0.05).
  
  
  CONCLUSIONS
  On average, high hospital volume results in more favorable outcomes during hospitalization after nephrectomy.
authors.affiliation: University of Montreal Health Center, Montreal, Quebec, Canada. mcw.sun@umontreal.ca
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome