The effect of minimally invasive and open radical prostatectomy surgeon volume

Choi, Wesley W.; Gu, Xiangmei; Lipsitz, Stuart R.; D'Amico, Anthony V.; Williams, Stephen B.; Hu, Jim C.

doi:10.1016/j.urolonc.2010.06.009

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The effect of minimally invasive and open radical prostatectomy surgeon volume

Wesley W. Choi, M.D.
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
Xiangmei Gu, M.S.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
Stuart R. Lipsitz, Ph.D.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
Anthony V. D'Amico, M.D., Ph.D.
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
Stephen B. Williams, M.D.
- Harvard Program in Urology, Brigham and Women's Hospital, Boston, MA 02115, USA
Jim C. Hu, M.D.
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
- J.C.H. was presented with a Department of Defense Prostate Cancer Physician Training Award, which funded this study.
- Corresponding author. Tel.: +1-617-732-4848; fax: +1-617-566-3475

Received 27 April 2010; accepted 10 June 2010. published online 07 September 2010.
Corrected Proof

Abstract

Objective:

To determine the effect of minimally invasive radical prostatectomy (MIRP) surgeon volume on outcomes, and correlate with those of open radical prostatectomy retropubic (ORP).

Methods and materials:

Observational population-based study of 8,831 men undergoing MIRP and ORP by 1,457 low, medium, and high volume surgeons from SEER-Medicare linked data from 2003 to 2007. After stratifying by surgeon ORP and MIRP volume, the following outcomes were studied: length of stay, transfusions, post-operative 30-day and anastomotic stricture complications, and use of additional cancer therapies.

Results:

Men undergoing MIRP with high and medium vs. low volume surgeons were less likely to require additional cancer therapies (4.5% and 4.7% vs. 7%, P = 0.020). Similarly, men undergoing ORP with high vs. medium and low volume surgeons were less likely to require additional cancer therapies (5.7% vs. 6.8% and 7.1%, P = 0.044). Men undergoing ORP with high vs. medium and low volume surgeons experienced shorter lengths of stay (2.9 vs. 3.3 and 3.6 days, P < 0.001), and fewer transfusions (15.4% vs. 21.3% and 22.7%, P = 0.017), 30-day complications (18.4% vs. 25.6% and 25.7%, P < 0.001), and anastomotic strictures (10.1% vs. 15.6% and 16.3%, P = 0.003). However, MIRP surgeon volume did not affect these outcomes.

Conclusions:

Men undergoing MIRP or ORP with high volume surgeons were less likely to require additional cancer therapies. Additionally, patients of high volume ORP surgeons were more likely to experience shorter hospital stays, fewer transfusions, 30-day complications, and anastomotic strictures, while MIRP surgeon volume did not affect these peri-operative outcomes.

Keywords: Surgeon volume, Surgical outcomes, Radical prostatectomy, Robotic surgery