title: Leapfrog volume thresholds and perioperative complications after radical prostatectomy.
abstract: BACKGROUND
  The authors explored the effect of Leapfrog volume thresholds (LVTs) on 5 short-term radical prostatectomy (RP) outcomes.
  
  
  METHODS
  Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), the authors focused on RPs performed within the 7 most contemporary years (2001-2007). They tested rates of in-hospital mortality, intraoperative complications, postoperative complications, and blood transfusions as well as the mean length of stay (LOS), stratified according to the number of LVTs that were met. Multivariable regression analyses were adjusted further for potential confounders.
  
  
  RESULTS
  Overall, 36.2%, 17.3%, 14.9%, 15.7%, 12.9%, and 3% of RPs were performed at institutions that reached 0 LVT, 1 LVT, 2 LVTs, 3 LVTs, 4 LVTs, and 5 LVTs, respectively. Relative to patients who underwent RP at institutions that reached 0 LVTs, patients who underwent RP at institutions that reached 5 LVTs had fewer comorbidities, were younger, were more likely to hold private insurance, and were more likely to undergo concomitant pelvic lymphadenectomy (all P < .001). In multivariable analyses adjusted for hospital volume (HV), age, race, year of surgery, Charlson Comorbidity Index, hospital region and location, pelvic lymphadenectomy, and insurance status, LVT status was related inversely to LOS and the likelihood of receiving blood transfusions (both P < .001).
  
  
  CONCLUSIONS
  The current results indicated that LVTs can provide a highly accurate prediction of the probability of 2 important, detrimental, short-term outcomes after RP, even after accounting for HV. The benefit at institutions that meet LVTs may exceed that at other institutions when short-term RP outcomes are considered. This observation should be taken into consideration when treatment decisions are made, especially because most RPs were performed at institutions that did not meet any LVTs.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA. trinh.qd@gmail.com
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Piyush K
authors.initials: PK
authors.lastname: Agarwal
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002983:Clinical Competence; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D017064:Process Assessment, Health Care; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D015996:Survival Rate