Association of surgeon and hospital volume with short-term outcomes after robot-assisted radical prostatectomy: Nationwide, population-based study.

Rebecka Arnsrud Godtman,Pär Stattin,Eva Johansson,Göran Ahlgren,Jonas Hugosson,Erik Persson,Fredrik Sandin,David Robinsson,Stefan Carlsson,Walter Cazzaniga

doi:10.1371/journal.pone.0253081

Abstract

Background and objectiveFew studies have investigated the association between surgical volume and outcome of robot-assisted radical prostatectomy (RARP) in an unselected cohort. We sought to investigate the association between surgical volume with peri-operative and short-term outcomes in a nation-wide, population-based study group.Methods9,810 RARP’s registered in the National Prostate Cancer Register of Sweden (2015–2018) were included. Associations between outcome and volume were analyzed with multivariable logistic regression including age, PSA-density, number of positive biopsy cores, cT stage, Gleason score, and extent of lymph node dissection.ResultsSurgeons and hospitals in the highest volume group compared to lowest group had shorter operative time; surgeon (OR 9.20, 95% CI 7.11–11.91), hospital (OR 2.16, 95% CI 1.53–3.06), less blood loss; surgeon (OR 2.58. 95% CI 2.07–3.21) hospital (no difference), more often nerve sparing intention; surgeon (OR 2.89, 95% CI 2.34–3.57), hospital (OR 2.02, 95% CI 1.66–2.44), negative margins; surgeon (OR 1.90, 95% CI 1.54–2.35), hospital (OR 1.28, 95% CI 1.07–1.53). There was wide range in outcome between hospitals and surgeons with similar volume that remained after adjustment.ConclusionsHigh surgeon and hospital volume were associated with better outcomes. The range in outcome was wide in all volume groups, which indicates that factors besides volume are of importance. Registration of surgical performance is essential for quality control and improvement.

Highlights

Already 40 years ago, Luft and colleagues described an association between high hospital surgical volume and lower mortality and suggested a centralization of certain surgical procedures [1]
Surgeons and hospitals in the highest volume group compared to lowest group had shorter operative time; surgeon, hospital, less blood loss; surgeon hospital, more often nerve sparing intention; surgeon, hospital, negative margins; surgeon, hospital
High surgeon and hospital volume were associated with better outcomes

Summary

Introduction

Already 40 years ago, Luft and colleagues described an association between high hospital surgical volume and lower mortality and suggested a centralization of certain surgical procedures [1]. Radical prostatectomy (RP) is no exception and numerous publications have reported an association between high volume and good outcomes including risk of complications, readmission, positive surgical margin, incontinence, risk of disease recurrence, mortality and costs [4, 5]. These reports have stimulated initiatives aiming at centralization of RP. The NICE guidelines state that at least 150 robot assisted radical prostatectomy (RARP)/year should be performed in a hospital in order to ensure cost-effectiveness [6] and in Germany, a minimum of 50 RP’s are required in order for a clinic to be a certified as a “prostate cancer center” [7]. We sought to investigate the association between surgical volume with peri-operative and short-term outcomes in a nation-wide, population-based study group

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Results

Conclusion