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

Godtman, Rebecka Arnsrud ; Persson, Erik ; Cazzaniga, Walter ; Sandin, Fredrik ; Carlsson, Stefan ; Ahlgren, Göran LU ; Johansson, Eva ; Robinsson, David ; Hugosson, Jonas and Stattin, Pär (2021) In PLoS ONE 16(6 June 2021).
Abstract

Background and objective Few 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. Methods 9,810 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. Results Surgeons and hospitals in the highest volume group compared to lowest group... (More)

Background and objective Few 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. Methods 9,810 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. Results Surgeons 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. Conclusions High 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.

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organization
publishing date
type
Contribution to journal
publication status
published
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in
PLoS ONE
volume
16
issue
6 June 2021
article number
e0253081
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:34138904
  • scopus:85108254865
ISSN
1932-6203
DOI
10.1371/journal.pone.0253081
language
English
LU publication?
yes
id
d827ab9b-08a0-450b-b998-02731c8cd0c5
date added to LUP
2021-07-16 10:55:38
date last changed
2022-08-19 06:16:50
@article{d827ab9b-08a0-450b-b998-02731c8cd0c5,
  abstract     = {{<p>Background and objective Few 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. Methods 9,810 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. Results Surgeons 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. Conclusions High 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.</p>}},
  author       = {{Godtman, Rebecka Arnsrud and Persson, Erik and Cazzaniga, Walter and Sandin, Fredrik and Carlsson, Stefan and Ahlgren, Göran and Johansson, Eva and Robinsson, David and Hugosson, Jonas and Stattin, Pär}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{6 June 2021}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Association of surgeon and hospital volume with short-term outcomes after robotassisted radical prostatectomy : Nationwide, population-based study}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0253081}},
  doi          = {{10.1371/journal.pone.0253081}},
  volume       = {{16}},
  year         = {{2021}},
}