TY - JOUR
T1 - Annual surgical caseload and open radical prostatectomy outcomes
T2 - Improving temporal trends
AU - Budäus, Lars
AU - Abdollah, Firas
AU - Sun, Maxine
AU - Morgan, Monica
AU - Johal, Rupinder
AU - Thuret, Rodolphe
AU - Zorn, Kevin C.
AU - Isbarn, Hendrik
AU - Shariat, Shahrokh F.
AU - Montorsi, Francesco
AU - Perrotte, Paul
AU - Graefen, Markus
AU - Karakiewicz, Pierre I.
PY - 2010/12
Y1 - 2010/12
N2 - Purpose Radical prostatectomy is the standard of care for localized prostate cancer. Numerous previous reports show the relationship between surgical experience and various outcomes. We examined the effect of surgical experience on complications and transfusion rates, and determined individual surgeon annual caseload trends in a contemporary radical prostatectomy cohort. Materials and Methods We analyzed annual caseload temporal trends in 34,803 patients who underwent surgery between 1999 and 2008 in Florida. Logistic regression models controlled for clustering among surgeons addressed the relationship of surgical experience, defined as the number of radical prostatectomies done since January 1, 1999 until each radical prostatectomy, with complications and transfusions. Results During the study period the proportion of surgeons in the high annual caseload tertile (24 radical prostatectomies or greater yearly) and the proportion of patients treated by those surgeons increased from 5% to 10% and from 20% to 55%, respectively. Conversely complication and transfusion rates decreased from 14.3% to 9.2% and 12.6% to 6.9%, respectively. Radical prostatectomies done by surgeons in the high surgical experience tertile (86 or greater radical prostatectomies) decreased the risk of any complication by 33% and of any transfusion by 30% vs those in patients operated on by surgeons in the low surgical experience tertile (27 or fewer radical prostatectomies). Conclusions The proportion of surgeons in the high annual caseload tertile and the proportion of patients treated by these surgeons steadily increased during the last decade. Complication and transfusion rates decreased with time. The implications of these encouraging findings may result in improved outcomes in patients with surgically managed prostate cancer.
AB - Purpose Radical prostatectomy is the standard of care for localized prostate cancer. Numerous previous reports show the relationship between surgical experience and various outcomes. We examined the effect of surgical experience on complications and transfusion rates, and determined individual surgeon annual caseload trends in a contemporary radical prostatectomy cohort. Materials and Methods We analyzed annual caseload temporal trends in 34,803 patients who underwent surgery between 1999 and 2008 in Florida. Logistic regression models controlled for clustering among surgeons addressed the relationship of surgical experience, defined as the number of radical prostatectomies done since January 1, 1999 until each radical prostatectomy, with complications and transfusions. Results During the study period the proportion of surgeons in the high annual caseload tertile (24 radical prostatectomies or greater yearly) and the proportion of patients treated by those surgeons increased from 5% to 10% and from 20% to 55%, respectively. Conversely complication and transfusion rates decreased from 14.3% to 9.2% and 12.6% to 6.9%, respectively. Radical prostatectomies done by surgeons in the high surgical experience tertile (86 or greater radical prostatectomies) decreased the risk of any complication by 33% and of any transfusion by 30% vs those in patients operated on by surgeons in the low surgical experience tertile (27 or fewer radical prostatectomies). Conclusions The proportion of surgeons in the high annual caseload tertile and the proportion of patients treated by these surgeons steadily increased during the last decade. Complication and transfusion rates decreased with time. The implications of these encouraging findings may result in improved outcomes in patients with surgically managed prostate cancer.
KW - Blood transfusion
KW - Complications
KW - Physicians practice patterns
KW - Prostate
KW - Prostatectomy
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U2 - 10.1016/j.juro.2010.08.024
DO - 10.1016/j.juro.2010.08.024
M3 - Article
C2 - 20952010
AN - SCOPUS:78349312682
VL - 184
SP - 2285
EP - 2290
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 6
ER -