title: Influence of hospital surgical volume of radical prostatectomy on quality of perioperative care.
abstract: OBJECTIVE
  We investigated the relationships between hospital surgical volume, surgical outcome, care plans indicated in critical pathways and actual perioperative care using data from a nationwide survey for radical prostatectomy.
  
  
  METHODS
  In this study, urologists from 155 hospitals in Japan cooperated in submitting the data of 4,029 patients who underwent radical prostatectomy in 2007, and the perioperative care plan in critical pathways. Of these, we analyzed data of 3,499 patients undergoing open radical prostatectomy and minimum incision endoscopic radical prostatectomy.
  
  
  RESULTS
  Increasing hospital volume was associated with decreased proportion of open radical prostatectomy (p < 0.001). As the hospital volume increased, surgical duration was significantly shorter (p < 0.001) and bleeding volume decreased (p < 0.004). Analyses of perioperative care suggested that low-volume hospitals (<15 patients annually) were likely to have longer care than medium-volume (15-29 patients per year) or high-volume (≥30 patients per year) hospitals, and the length of actual care was prolonged in the low-volume hospitals. Multivariate logistic regression analysis suggested that the occurrence of postoperative complications was significantly associated with surgeon's volume (p = 0.004), patient age (p = 0.001), preoperative anticoagulant therapy (p = 0.045), coexistent diabetes mellitus (p = 0.009), surgical duration (p = 0.002) and bleeding volume (p < 0.001), but not hospital volume.
  
  
  CONCLUSIONS
  Urologists in high-volume hospitals appeared to attempt new types of surgery. Hospital surgical volume was strongly associated with the surgical duration, bleeding volume and planned and actual perioperative care; however, it was not associated with postoperative complications.
authors.affiliation: Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nojiri
authors.forename: Kikuo
authors.initials: K
authors.lastname: Okamura
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yanaihara
authors.forename: Naoto
authors.initials: N
authors.lastname: Sassa
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Jiroh
authors.initials: J
authors.lastname: Machida
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hashine
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects*; D011183:Postoperative Complications / Q000473:pathology; D011468:Prostatectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*