The effect of annual surgical caseload on the rates of in-hospital pneumonia and other in-hospital outcomes after radical prostatectomy.

Purpose: To examine the effect of annual surgical caseload (ASC) on contemporary in-hospital pneumonia (IHP) rates and three other in-hospital outcomes after radical prostatectomy (RP).
Methods: Between 1999 and 2008, 34,490 open RPs were performed in the state of Florida. First, logistic regression models predicting the rate of IHP were fitted. Second, other logistic regression models examined the association between IHP and three other outcomes: in-hospital mortality, hospital charges within the highest quartile, and length of stay (LOS) within the highest quartile. Covariates included ASC, age, race, baseline Charlson Comorbidity Index (CCI), interval between admission and surgery, as well as blood transfusion.
Results: The overall IHP rate was 0.5%. It was higher in patients operated within the low (0.7%) and intermediate (0.5%) ASC tertile versus high ASC tertile (0.2%, P < 0.001). Mortality rate was 4.3% in IHP patients versus 0.1% in others (P < 0.001). Median total hospital charges and median LOS were $55,350 versus $28,171 and 7 versus 3 days in IHP patients versus others, respectively (both P < 0.001). In multivariable analyses predicting IHP, the likelihood was 3.2-fold in patients operated by low ASC surgeons versus high ASC surgeons (P < 0.001). Second, in multivariable analyses, IHP patients were predisposed to 41-fold higher in-hospital mortality, were tenfold more likely to have total hospital charges >$37,333, and were 20-fold more likely to have a LOS >3 days (all P < 0.001).
Conclusions: RP by high ASC surgeons exerts a protective effect on IHP rates. Additionally, IHP is associated with higher in-hospital mortality, prolonged LOS, and higher hospital charges.