Variations in Morbidity after Radical Prostatectomy

• Published in: The New England journal of medicine Vol. 346; no. 15; pp. 1138 - 1144
• Main Authors: Begg, Colin B, Riedel, Elyn R, Bach, Peter B, Kattan, Michael W, Schrag, Deborah, Warren, Joan L, Scardino, Peter T
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 11.04.2002
• Subjects: Aged; Biological and medical sciences; Clinical outcomes; General Surgery - manpower; General Surgery - statistics & numerical data; Health maintenance organizations; HMOs; Hospitalization; Hospitals; Hospitals - utilization; Humans; Male; Medical sciences; Medicare; Outcome Assessment (Health Care); Postoperative Complications - epidemiology; Postoperative Complications - mortality; Prostate cancer; Prostatectomy - adverse effects; Prostatectomy - mortality; Prostatectomy - utilization; Prostatic Neoplasms - surgery; SEER Program; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; United States - epidemiology; Urinary Incontinence - epidemiology; Urinary Incontinence - etiology; Urologic Diseases - epidemiology; Urologic Diseases - etiology; United States; Human; Postoperative; Prevalence; Surgery; Cohort study; Mortality; Complication; Prostatectomy; Radical; Survival
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMsa011788

Radical prostatectomy is commonly performed in men with early-stage prostate cancer. This study assessed the outcome of surgery in relation to the number of prostatectomy procedures performed at individual hospitals (hospital volume) and by individual surgeons (surgeon volume). Neither hospital volume nor surgeon volume was related to operative mortality. However, postoperative complications and late urinary complications were more common in patients treated at low-volume hospitals or by low-volume surgeons than in those treated at high-volume hospitals or by high-volume surgeons. Studies of the outcomes of surgery for cancer have typically focused on the number of procedures performed at a hospital (hospital volume) as a proxy for the experience of the surgeons who operate at the hospital. The observation that there are consistent relations between increased numbers of operations and better outcomes among patients has led to in-depth investigations to determine the differences in the processes of care that explain the variations. If the trends are especially strong, an argument can be made for regionalizing care on the basis of hospital volume alone — that is, referring patients to high-volume hospitals. . . .