1862 SURGEON VOLUME-OUTCOME RELATIONSHIPS IN THE TREATMENT OF RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111862 SURGEON VOLUME-OUTCOME RELATIONSHIPS IN THE TREATMENT OF RENAL MASSES Robert Abouassaly, Shabbir M.H. Alibhai, George A. Tomlinson, David R. Urbach, and Antonio Finelli Robert AbouassalyRobert Abouassaly Cleveland, OH More articles by this author , Shabbir M.H. AlibhaiShabbir M.H. Alibhai Toronto, Canada More articles by this author , George A. TomlinsonGeorge A. Tomlinson Toronto, Canada More articles by this author , David R. UrbachDavid R. Urbach Toronto, Canada More articles by this author , and Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1909AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Volume-outcome relationships have been noted in a number of major surgical procedures. Outcomes of these complex procedures tend to be better for high volume hospitals and providers. The aim of our study was to determine the relationship between provider volume, and partial nephrectomy (PN) use and morbidity in the treatment of renal masses. METHODS Using data from a national discharge abstract database, we performed a population-based, retrospective, observational study. Data were available on 24,579 patients treated surgically for a renal mass from April 1998 to March 2008. Surgeon volume quartiles were created using the total number of nephrectomies during the 10-year observation period. In-hospital complications and comorbidity were identified using specific ICD-9 and 10 diagnosis and procedure codes. The Charlson-Deyo Index was used to adjust for comorbidity. PN use, complication rates, and 30-day mortality were compared between surgeon volume quartiles using the Chi-square test. The effect of surgeon volume on our outcome variables was determined using multivariable logistic regressions, adjusted for covariates (including hospital volume). RESULTS Overall, PN use, in-hospital complications and mortality occurred in 4,292 (17.5%), 8,406 (34.2%) and 295 (1.2%) patients, respectively. PN use occurred in 10.9% of low volume, compared with 24.7% of very high volume surgeons (p<.0001). A modest decrease in complications was observed with increasing surgeon volume (37.6% among low vs. 34.5% among very high volume, p<.0001). The effect of in-hospital mortality was more dramatic, with rates of 1.71%, 1.20%, 0.97% and 0.92% observed among low, intermediate, high and very high volume surgeons, respectively (p<.0001). After adjusting for covariates, compared with low volume surgeons, patients treated by very high volume surgeons had 1.54 the odds of being treated with PN (95% CI 1.37–1.72, p<.0001), 0.84 the odds of experiencing an in-hospital complication (95% CI 0.77–0.92, p<.0001), and 0.69 the odds of dying in-hospital (95% CI 0.47–1.01, p=0.16). CONCLUSIONS Our large, population-based study suggests that surgeon volume-outcome relationships exist in kidney surgery for renal masses. Higher volume surgeons use PN more often, experience lower complication rates, and may have lower in-hospital mortality rates than lower volume surgeons. Understanding the factors contributing to these differences would facilitate knowledge transfer initiatives, and would likely improve surgical outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e747 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Abouassaly Cleveland, OH More articles by this author Shabbir M.H. Alibhai Toronto, Canada More articles by this author George A. Tomlinson Toronto, Canada More articles by this author David R. Urbach Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...