Determining the Key to Success for Radical Prostatectomy: Is There a Surrogate Measure for a Meaningful Clinical Outcome?
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Purpose
Outcomes of radical prostatectomy are prone to publication bias, because most of the data originated from highly specialized centers. We assessed in-hospital outcomes of all radical prostatectomies in Germany from 2006 to 2013 focusing on caseload volume, surgical approach, and certification status.
Methods
We analyzed the nationwide German hospital billing data covering 221,331 radical prostatectomies from 2006 to 2013. Outcomes were in-hospital mortality, surgical revision, and transfusion rates and the length of stay. Multivariate models described the impact of these factors.
Results
The yearly number of radical prostatectomies declined from 28,374 to 21,850. While shares of all other approaches decreased, shares for robot-assisted prostatectomy increased from 0.6 to 25.2%. Hospitals with ≥100 cases a year reported lower in-hospital mortality with 0.08 versus 0.17% for hospitals with <50 cases a year. On multivariate analysis, the odds for an individual death were doubled in hospitals with <50 cases a year. All other factors showed no significant impact on mortality. Concerning blood transfusion, the surgical approach was the strongest predictor with minimally invasive surgery (26% of the odds of conventional surgery) followed by caseload volume. Surgical revision was frequent in hospitals with lower rates of minimally invasive approaches (OR 1.6) and smaller caseloads (OR 1.4). Length of stay was reduced by 3 days for caseloads ≥200 a year, 2 days with minimally invasive approaches, and 1 day in certified prostate cancer centers. Lacking clinical information is a major limitation.
Conclusions
Annual caseload volume of hospitals is the most important factor for improved in-hospital outcomes.
Keywords
Prostate cancer Prostatectomy Caseload Robotics Health services research
Abbreviations
ORPE Retropubic radical prostatectomy
LRPE Laparoscopic radical prostatectomy
RRPE Robot-assisted radical prostatectomy
PRBC Packed red blood cells
ICD International classification of diseases
OPS Classification of Operations and Procedures
Destatis German Federal Statistical Office
Part of this study was presented at the Annual Meeting of the European Association of Urology in 2016.
Purpose
Outcomes of radical prostatectomy are prone to publication bias, because most of the data originated from highly specialized centers. We assessed in-hospital outcomes of all radical prostatectomies in Germany from 2006 to 2013 focusing on caseload volume, surgical approach, and certification status.
Methods
We analyzed the nationwide German hospital billing data covering 221,331 radical prostatectomies from 2006 to 2013. Outcomes were in-hospital mortality, surgical revision, and transfusion rates and the length of stay. Multivariate models described the impact of these factors.
Results
The yearly number of radical prostatectomies declined from 28,374 to 21,850. While shares of all other approaches decreased, shares for robot-assisted prostatectomy increased from 0.6 to 25.2%. Hospitals with ≥100 cases a year reported lower in-hospital mortality with 0.08 versus 0.17% for hospitals with <50 cases a year. On multivariate analysis, the odds for an individual death were doubled in hospitals with <50 cases a year. All other factors showed no significant impact on mortality. Concerning blood transfusion, the surgical approach was the strongest predictor with minimally invasive surgery (26% of the odds of conventional surgery) followed by caseload volume. Surgical revision was frequent in hospitals with lower rates of minimally invasive approaches (OR 1.6) and smaller caseloads (OR 1.4). Length of stay was reduced by 3 days for caseloads ≥200 a year, 2 days with minimally invasive approaches, and 1 day in certified prostate cancer centers. Lacking clinical information is a major limitation.
Conclusions
Annual caseload volume of hospitals is the most important factor for improved in-hospital outcomes.
Keywords
Prostate cancer Prostatectomy Caseload Robotics Health services research
Abbreviations
ORPE Retropubic radical prostatectomy
LRPE Laparoscopic radical prostatectomy
RRPE Robot-assisted radical prostatectomy
PRBC Packed red blood cells
ICD International classification of diseases
OPS Classification of Operations and Procedures
Destatis German Federal Statistical Office
Part of this study was presented at the Annual Meeting of the European Association of Urology in 2016.
