Busy surgeons have better results

When it comes to having a radical prostatectomy, do patients fare better in a hospital that handles a large number of surgeries versus one that handles relatively few? Is the number of operations performed by a particular surgeon a better gauge of patient outcomes than hospital volume?

Although similar questions have been answered for other surgical procedures, the relationship between numbers of prostate surgeries and how well patients do has not been evaluated on a large scale until now. To find out, Minnesota researchers reviewed 17 previously published studies that reported the results of 235,763 radical prostatectomies.

They determined that hospitals where more than 43 prostatectomies were performed per year had lower mortality rates than smaller-volume hospitals. Patients at these high-volume hospitals were also 9.7% less likely to experience complications. Teaching hospitals had an 18% lower rate of complications.

Interestingly, the number of operations a surgeon performed did not significantly affect mortality rates or the chances of having left some of the cancer behind. But the number of operations a surgeon performed in a year did affect the chances of urinary complications — for every 10 additional radical prostatectomies the surgeon performed, the urinary complication rate dropped by 2.4%.

Although many patients may be restricted in their choice of hospital based on where they live or their insurance plan, the findings suggest that prostate patients do better when surgery is done at a high-volume hospital by a doctor who performs the operation regularly.

SOURCE: Wilt TJ, Shamliyan TA, Taylor BC, et al. Association Between Hospital and Surgeon Radical Prostatectomy Volume and Patient Outcomes: A Systematic Review. Journal of Urology 2008;180:820–28. PMID: 18635233.

Originally published Oct. 1, 2008; Last reviewed April 11, 2011

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