title: Annual prostatectomy volume is related to rectal laceration rate after radical prostatectomy.
abstract: OBJECTIVE
  To examine the effect of annual prostatectomy volume (APV) on contemporary intraoperative rectal laceration (RL) rates after radical prostatectomy.
  
  
  METHODS
  From 1999 to 2008, 36 699 radical prostatectomy procedures were performed in Florida. First, logistic regression models predicting the RL rate were fitted. Second, other logistic regression models were used to examine the association between RL and 2 other secondary outcomes: prolonged length of stay (>3 days) and increased hospital charges (>$37 621). The covariates included APV quintiles, surgical approach (minimally invasive vs open radical prostatectomy), lymph node dissection status, age, year of surgery, race, and baseline Charlson comorbidity index.
  
  
  RESULTS
  The overall RL rate was 0.7%. The RL rate was 0.3%, 0.6%, 0.7%, 0.9%, and 1.0% for the very high, high, intermediate, low, and very low APV quintiles, respectively (P < .001). In multivariate analyses predicting RL, patients treated by intermediate (odds ratio 2.39, P = .003), low (odds ratio 2.95, P < .001), and very low (odds ratio 3.26, P < .001) APV surgeons had a greater likelihood of experiencing an RL relative to patients treated by very high APV surgeons. Second, in the multivariate analyses, patients with a RL were 9.1-fold more likely to have a prolonged length of stay (P < .001) and were 3.4-fold more likely to have increased total hospital charges (P < .001).
  
  
  CONCLUSIONS
  A greater APV exerts a protective effect on RL rates. Additionally, RL increases the length of stay and 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: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Lars
authors.initials: L
authors.lastname: Budäus
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Christian
authors.initials: C
authors.lastname: Eichelberg
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; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D022125:Lacerations / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011468:Prostatectomy / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012007:Rectum / Q000293:injuries; D012307:Risk Factors