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Associations between Hospital Volume and Outcomes of Robot-Assisted Radical Prostatectomy

2019; Lippincott Williams & Wilkins; Volume: 203; Issue: 5 Linguagem: Inglês

10.1097/ju.0000000000000698

1527-3792

Leilei Xia, Colin Sperling, Benjamin Taylor, Ruchika Talwar, Raju Chelluri, Jay D. Raman, Daniel J. Lee, David I. Lee, Thomas J. Guzzo,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyAdult Urology1 May 2020Associations between Hospital Volume and Outcomes of Robot-Assisted Radical ProstatectomyThis article is commented on by the following:Editorial Comment Leilei Xia, Colin D. Sperling, Benjamin L. Taylor, Ruchika Talwar, Raju R. Chelluri, Jay D. Raman, Daniel J. Lee, David I. Lee, and Thomas J. Guzzo Leilei XiaLeilei Xia *Correspondence: Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, West Pavilion, 3rd Floor, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104 telephone: 215-662-2891; FAX: 215-662-7413; E-mail Address: [email protected] Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Colin D. SperlingColin D. Sperling Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Benjamin L. TaylorBenjamin L. Taylor Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York , Ruchika TalwarRuchika Talwar Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia , Raju R. ChelluriRaju R. Chelluri Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Jay D. RamanJay D. Raman Division of Urology, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania , Daniel J. LeeDaniel J. Lee Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia , David I. LeeDavid I. Lee Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , and Thomas J. GuzzoThomas J. Guzzo Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia View All Author Informationhttps://doi.org/10.1097/JU.0000000000000698AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Robot-assisted radical prostatectomy has become the predominant surgical modality to manage localized prostate cancer in the U.S. However, there are few studies focusing on the associations between hospital volume and outcomes of robot-assisted radical prostatectomy. Materials and Methods: We identified robot-assisted radical prostatectomies for clinically localized (cT1-2N0M0) prostate cancer diagnosed between 2010 and 2014 in the National Cancer Database. We categorized annual average hospital robot-assisted radical prostatectomy volume into very low, low, medium, high and very high by most closely sorting the final included patients into 5 equal-sized groups (quintiles). Outcomes included 30-day mortality, 90-day mortality, conversion (to open), prolonged length of stay (more than 2 days), 30-day (unplanned) readmission, positive surgical margin and lymph node dissection rates. Results: A total of 114,957 patients were included in the study, and hospital volume was categorized into very low (3 to 45 cases per year), low (46 to 72), medium (73 to 113), high (114 to 218) and very high (219 or more). Overall 30-day mortality (0.12%), 90-day mortality (0.16%) and conversion rates (0.65%) were low. Multivariable logistic regressions showed that compared with the very low volume group, higher hospital volume was associated with lower odds of conversion to open surgery (OR 0.23, p <0.001 for very high), prolonged length of stay (OR 0.25, p <0.001 for very high), 30-day readmission (OR 0.53, p <0.001 for very high) and positive surgical margins (OR 0.61, p <0.001 for very high). Higher hospital volume was also associated with higher odds of lymph node dissection in the intermediate/high risk cohort (OR 3.23, p <0.001 for very high). Conclusions: Patients undergoing robot-assisted radical prostatectomy at higher volume hospitals are likely to have improved perioperative and superior oncologic outcomes compared to lower volume hospitals. References 1. : Updates in urologic robot assisted surgery. F1000Res 2018; 7: 1948. Google Scholar 2. : Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. 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Google Scholar 30. : Generalizability of the Prostate Cancer Intervention Versus Observation Trial (PIVOT) results to contemporary North American men with prostate cancer. Eur Urol 2017; 71: 511. Google Scholar The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed or the conclusions drawn from these data by the investigators. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1025 and 1026. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByBerger A, Tan-Kim J and Menefee S (2021) The Impact of Surgical Center Volume on Reoperation Risk after Mid Urethral SlingJournal of Urology, VOL. 206, NO. 6, (1454-1460), Online publication date: 1-Dec-2021.Smith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 203, NO. 5, (851-853), Online publication date: 1-May-2020.Related articlesJournal of UrologyFeb 3, 2020, 12:00:00 AMEditorial Comment Volume 203Issue 5May 2020Page: 926-932Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordshospitalstreatment outcomehigh-volumeprostatic neoplasmsroboticsprostatectomyMetricsAuthor Information Leilei Xia Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia *Correspondence: Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, West Pavilion, 3rd Floor, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104 telephone: 215-662-2891; FAX: 215-662-7413; E-mail Address: [email protected] More articles by this author Colin D. Sperling Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia More articles by this author Benjamin L. Taylor Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York More articles by this author Ruchika Talwar Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia More articles by this author Raju R. Chelluri Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia More articles by this author Jay D. Raman Division of Urology, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania More articles by this author Daniel J. Lee Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia More articles by this author David I. Lee Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia More articles by this author Thomas J. Guzzo Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia More articles by this author Expand All The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed or the conclusions drawn from these data by the investigators. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1025 and 1026. Advertisement PDF DownloadLoading ...