title: Impact of Surgeon and Hospital Volume on the Safety of Robot-Assisted Radical Prostatectomy: A Multi-Institutional Study Based on a National Database.
abstract: BACKGROUND
  We aimed to perform a multi-institutional study using a national database led by the Japanese Society of Endourology to investigate the effect of surgeon or hospital volume on the safety of robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  Clinical data of 3,214 patients who underwent RARP for the treatment of clinically localized prostate cancer between April 2012 and March 2013 in Japan were evaluated. Surgical outcomes and all intra- and perioperative complications were collected.
  
  
  RESULTS
  The intraoperative complication rate was 0.56%. In a total number of 241 patients, 261 perioperative complications were observed. The following percentages of patients presented the Clavien-graded complications: 7.2%, grades 1-2; 0.84%, grade 3; and 0.093%, grade 4a. No cases of multiple organ dysfunction or death (grades 4b and 5) were found. Multivariable logistic regression analysis showed that the hospital volume (OR 3.6; p = 0.010) for intraoperative complications and surgeon volume (OR 0.19; p < 0.0001) and extended lymph node discectomy (OR 3.9; p < 0.0001) for perioperative complications were significant independent risk factors.
  
  
  CONCLUSIONS
  Hospital volume for intraoperative complications and surgeon volume and extended lymph node dissection for perioperative complications were significantly associated with increased risk of each complication in RARP.
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Hirasawa
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.forename: Masumi
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Shiroki
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tozawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukasawa
authors.forename: Akira
authors.initials: A
authors.lastname: Kashiwagi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Tatsugami
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D006801:Humans; D007432:Intraoperative Period; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061214:Patient Safety; D011183:Postoperative Complications; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014572:Urology / Q000379:methods