Impact of surgical experience on in-hospital complication rates in patients undergoing minimally invasive prostatectomy: A population-based study

Lars Budäus, Maxine Sun, Firas Abdollah, Kevin C. Zorn, Monica Morgan, Rupinder Johal, Daniel Liberman, Rodolphe Thuret, Hendrik Isbarn, Georg Salomon, Alexander Haese, Francesco Montorsi, Shahrokh F. Shariat, Paul Perrotte, Markus Graefen, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Background. The relationship between provider volume and complication and transfusion rates in patients undergoing minimally invasive prostatectomy (MIRP) for prostate cancer has not been assessed. Temporal trends in MIRP annual surgical caseload (AC), impact of MIRP surgical experience (SE), and in-hospital complication and transfusion rates were evaluated. Methods. Between 2002 and 2008, 2,666 patients in Florida underwent MIRP. Surgical experience was defined as the number of procedures performed from the beginning of the study until each individual MIRP. Multivariable logistic regression models using generalized estimating equations assessed the relationship between SE and inhospital complication and transfusion rates. Results. Overall AC and SE ranged from 1-171 and 1-500, respectively. Between 2002 and 2005, 94-100% of surgeons were considered as low AC tertile (≤15 MIRP) vs. 76-82% between 2006 and 2008. For the same time periods, low AC tertile surgeons performed 46-100 and 27-32% of all MIRPs respectively. Multivariable logistic regression models revealed 51 and 68% lower complication rates in patients operated on by surgeons of intermediate (17-76 MIRPs) and high SE (≥77 MIRPs) relative to surgeons of low SE (≤16 MIRPs). Similarly, transfusion rates were 80 and 83% lower for the same groups. Conclusions. Our study is the first to indicate that high SE reduces MIRP complication and transfusion rates. Despite this observation, even in the most contemporary study year, most MIRP surgeons (82%) were in the low AC tertile and contributed to as many as 32% of all MIRPs. These findings should be considered at informed consent.

Original languageEnglish
Pages (from-to)839-847
Number of pages9
JournalAnnals of Surgical Oncology
Volume18
Issue number3
DOIs
Publication statusPublished - Mar 2011

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Budäus, L., Sun, M., Abdollah, F., Zorn, K. C., Morgan, M., Johal, R., Liberman, D., Thuret, R., Isbarn, H., Salomon, G., Haese, A., Montorsi, F., Shariat, S. F., Perrotte, P., Graefen, M., & Karakiewicz, P. I. (2011). Impact of surgical experience on in-hospital complication rates in patients undergoing minimally invasive prostatectomy: A population-based study. Annals of Surgical Oncology, 18(3), 839-847. https://doi.org/10.1245/s10434-010-1300-0