title: The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy.
abstract: OBJECTIVE
  Although high-volume hospitals have been associated with improved outcomes for radical prostatectomy (RP), the association of residency or fellowship teaching institutions or both and this volume-outcome relationship remains poorly described. We examine the effect of teaching status and hospital volume on perioperative RP outcomes.
  
  
  METHODS
  Within the Nationwide Inpatient Sample, we focused on RPs performed between 2003 and 2007. We tested the rates of prolonged length of stay beyond the median of 3 days, in-hospital mortality, and intraoperative and postoperative complications, stratified according to teaching status. Multivariable logistic regression analyses further adjusted for confounding factors.
  
  
  RESULTS
  Overall, 47,100 eligible RPs were identified. Of these, 19,193 cases were performed at non-teaching institutions, 24,006 at residency teaching institutions, and 3,901 at fellowship teaching institutions. Relative to patients treated at non-teaching institutions, patients treated at fellowship teaching institutions were healthier and more likely to hold private insurance. In multivariable analyses, patients treated at residency (OR = 0.92, P = 0.015) and fellowship (OR = 0.82, P = 0.011) teaching institutions were less likely to experience a postoperative complication than patients treated at non-teaching institutions. Patients treated at residency (OR = 0.73, P<0.001) and fellowship (OR = 0.91, P = 0.045) teaching institutions were less likely to experience a prolonged length of stay.
  
  
  CONCLUSIONS
  More favorable postoperative complication profile and shorter length of stay should be expected at residency and fellowship teaching institutions following RP. Moreover, postoperative complication rates were lower at fellowship teaching than at residency teaching institutions, despite adjustment for potential confounders.
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: trinh.qd@gmail.com.
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors: Maxine
authors: M
authors: Sun
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Simon P
authors: SP
authors: Kim
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Jesse
authors: J
authors: Sammon
authors: Department of Urology, Georgetown University Hospital, Washington, DC.
authors: Keith J
authors: KJ
authors: Kowalczyk
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Ariella A
authors: AA
authors: Friedman
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Shyam
authors: S
authors: Sukumar
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Praful
authors: P
authors: Ravi
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Fred
authors: F
authors: Muhletaler
authors: Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA.
authors: Piyush K
authors: PK
authors: Agarwal
authors: Department of Urology, Weill Medical College of Cornell University, New York, NY.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
authors: Jim C
authors: JC
authors: Hu
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Mani
authors: M
authors: Menon
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000368:Aged; D006739:Hospital Administration; D006761:Hospitals; D006784:Hospitals, Teaching; D006801:Humans; D007348:Insurance, Health; D007396:Internship and Residency / Q000458:organization & administration*; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
keywords: Complication; Fellowship; Prostatectomy; Prostatic neoplasms; Residency; Teaching