“It might seem intuitive that the more surgeries you perform the better you get,” said senior author Mark S. Litwin, professor of urology and health services at UCLA’s David Geffen School of Medicine and School of Public Health, and Jonsson Cancer Center researcher. “But there is a growing interest in the association of case volume and surgical outcome. Our study found substantial evidence that surgeon experience is associated with lower complication rates in radical prostatectomy.”
Acccording to Litwin, although research has largely investigated the impact of hospital and surgeon volume on patient mortality, few studies have addressed the association in common procedures like radical prostatectomy that have low mortality rates. Researchers have just begun to examine the impact of volume on postoperative complications for a broader range of surgeries, including cancer surgery.
UCLA researchers used Medicare claims data, and examined the association of hospital and surgeon volume with in-hospital complications, length of stay, and common postoperative complications in 2,292 men, age 65 and older, who underwent radical prostatectomy in 1997 or 1998. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, and other surgical and medical conditions. Surgeons and hospitals were classified as high- or low-volume depending on cumulative operative experience in 1997 and 1998.
Low-volume surgeons had twice the in-hospital complication rate of high-volume surgeons, and their patients were hospitalized one day longer on average. After adjusting for physician volume, hospital case volume was not significantly associated with complications or length of stay.
Litwin indicated that the results of this study confirm findings of similar studies examining the impact of surgeon experience on radical prostatectomy and surgery for other diseases. He also emphasized the study’s substantial policy implications:
“In the late 1980s and early 1990s there was tremendous pressure to decrease health care costs. Now that progress has been made in this area, we are seeing increased attention to improving the quality of services in health-care settings. As employers seek to improve the quality of care for their employees, we may see information from these studies used to control referrals and direct employees to higher-volume providers.”
Litwin emphasized that study results only apply to radical prostatectomy among men 65 and older and must be carefully applied when looking at surgery among younger men.
In terms of implications for patients, Litwin emphasized, “Given that prostate cancer is the most common cancer among men in the U.S. and the second most common cause of cancer death in men, the study highlights the importance of patients asking their doctors both about treatment options and surgical experience before undergoing radical prostatectomy.”
Journal
Journal of Clinical Oncology