title: Association between surgeon and hospital characteristics and lymph node counts from radical prostatectomy and pelvic lymph node dissection.
abstract: OBJECTIVE
  To assess whether surgical approach and hospital characteristics independently determine the number of lymph nodes (LNs) removed from prostate cancer patients undergoing radical prostatectomy (RP) and pelvic LN dissection (PLND).
  
  
  METHODS
  Using the National Cancer Database, we identified all surgically treated patients diagnosed with pretreatment intermediate- or high-risk prostate cancer from 2010 to 2011. The primary outcome was the number of LNs retrieved at the time of RP. Generalized estimating equations were used to assess for differences in the adjusted number of LNs retrieved after accounting for patient and hospital characteristics and surgical approach.
  
  
  RESULTS
  Overall, 35,876 patients were diagnosed with intermediate-risk (61.2%) and high-risk (38.8%) prostate cancer and underwent RP and PLND.On multivariate analysis, open RP and high-volume and academic hospitals were independently associated with greater LN counts compared with robotic-assisted RP and medium or low and community hospitals, respectively (all P <.001). After adjusting for patient and hospital variables, higher adjusted LN counts were observed for open RP compared with robotic-assisted RP (7.1 vs 6.1; P <.001). Adjusted counts were also higher for high-volume hospitals compared with medium- or low-volume hospitals (7.8 vs 5.9; P <.001), and academic compared with community hospitals (7.3 vs 5.6; P <.001).
  
  
  CONCLUSIONS
  Among patients with aggressive prostate cancer treated with RP and PLND, retrieval of LN counts varied by surgical approach and hospital characteristics.
authors: Yale University, School of Medicine, New Haven, CT.
authors: Elyn H
authors: EH
authors: Wang
authors: Department of Radiation Oncology, Yale University, New Haven, CT; Yale University, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors: James B
authors: JB
authors: Yu
authors: Yale University, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Internal Medicine, Yale University, New Haven, CT.
authors: Cary P
authors: CP
authors: Gross
authors: University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; University Hospital Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland, OH; Seidman Cancer Center, Case Western Comprehensive Medical Center, Cleveland OH.
authors: Robert
authors: R
authors: Abouassaly
authors: University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; University Hospital Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland, OH; Seidman Cancer Center, Case Western Comprehensive Medical Center, Cleveland OH.
authors: Edward E
authors: EE
authors: Cherullo
authors: Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA.
authors: Marc C
authors: MC
authors: Smaldone
authors: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
authors: Nilay D
authors: ND
authors: Shah
authors: University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH.
authors: Jonathon
authors: J
authors: Kiechle
authors: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: University of Montreal, Montreal, Canada.
authors: Maxine
authors: M
authors: Sun
authors: Yale University, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; University Hospital Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland, OH; Seidman Cancer Center, Case Western Comprehensive Medical Center, Cleveland OH. Electronic address: Simon.Kim@UHhospitals.org.
authors: Simon P
authors: SP
authors: Kim
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006761:Hospitals / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics