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

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

Details

Database :
OAIster
Notes :
application/pdf, English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1280665129
Document Type :
Electronic Resource
Full Text :
https://doi.org/10.1371.journal.pone.0253081