Table 2.
Characteristics of studies examining the association between surgeon volume and patient outcome after radical prostatectomy*
| Study | Design | Data source | Risk adjustment | Surgical volume | End points |
|---|---|---|---|---|---|
| Litwiller et al [38] | Retrospective | Hospital records (n = 428), 1984–1994 | Age, CCI, tumor stage | Continuously coded | Estimated blood loss: p > 0.05 Blood transfusion: p > 0.05 Prolonged length of stay: r2: 0.23; p < 0.05 |
| Karakiewicz et al [25] | Retrospective | Quebec Health Plan Claims Data (n = 4997), 1988–1996 | Age, physician age, hospital type, year of surgery | Continuously coded | 30-d mortality: p > 0.05 |
| Leibman et al [37] | Planned Clinical Pathway Implementation Baseline Analysis | Hospital records, before and after pathway implementation (n = 856), 1994–1997 | – | RP volume categorized in 2 groups: low (<12), high (≥12) | Prolonged length of stay: low (5.8 d), high (5.3 d); p < 0.001 Hospital charges: low ($11 798), high ($11 113); p < 0.001 |
| Eastham et al [47] | Retrospective | Hospital records (n = 4269), 1983–2002 | PSA, clinical stage, tumor grade, surgery data, surgeon | Continuously coded | Positive surgical margins: coefficient: −0.0007; p = 0.01 |
| Dash et al [43] | Prospective | Consecutive prospectively enrolled patients | Age, race, Administration of hormonal therapy, clinical stage, tumor grade, prostate volume anesthesia type | RP volume categorized in 2 groups: low (≤15), high (>15/yr) | Blood transfusion (OR; 95% CI): low vs high (8.6; 3.95–18.86) |
| Bianco et al [42] | Retrospective | SEER Medicare claims (n = 5238), 1992–1996 | Age, CCI, stage, hospital volume | RP volume categorized in 2 groups: low (<20), high (≥20/yr) | Perioperative Complications p < 0.001 Late urinary Complications p < 0.001 Long-term incontinence: p < 0.001 |
| Chun et al [46] | Retrospective | Hospital records (n = 2402), 1996–2004 | PSA, clinical stage, tumor grade | Continuously coded | Positive surgical margins (OR; p value): 1.01; p < 0.001 |
| Ramirez et al [61] | Retrospective | Florida Inpatient Data | Age, CCI, race | Continuous | Total hospital charges (coefficient, p value): −25.0, p < 0.001) |
| Vickers et al [71] | Retrospective | Multi-institutional series (n = 7765), 1987–2003 | PSA, clinical stage, tumor grade | RP volume categorized in 5 groups: 1st (<50), 2nd (50–99), 3rd (100–249), 4th (250–999), 5th (>999) | Biochemical recurrence (%; 95% CI): ≤10 cases (18%; 12–26%) >250 cases (11%; 7–16%); p < 0.001 |
| Briganti et al [59] | Retrospective | Institutional series (n = 120), 2002–2007 | PSA, clinical stage, tumor grade | RP volume categorized in 2 groups: low (≤144 extended PLND), high (>144 extended PLND) and Continuously coded | Lymph node invasion (OR; p value): continuously coded (1.001; p = 0.04), high vs low (1.8; p = 0.009) |
| Hu et al [41] | Retrospective | SEER Medicare claims (n = 2702), 2003–2005 | Age, CCI, race, hospital region | Continuously coded | Perioperative complications (OR; 95% CI): 0.98; 0.95–1.02); p = 0.05 Prolonged length of stay (coefficient; 95% CI): 0.006 (−0.03; 0.04) Risk of salvage therapy (OR; 95% CI): 0.92; 0.88–0.98; p < 0.05) Anastomotic strictures (OR; 95% CI): 0.93; 0.87–0.99; p < 0.05 |
| Jeldres et al [27] | Retrospective | Quebec Health Plan Claims Data (n = 7937), 1989–2000 | Age, CCI | Cubic spline | Risk of secondary therapy: biphasic relationship: p = 0.02 (up to 24 RPs performed) |
| Klein et al [53] | Retrospective | Multi-institutional series (n = 7683), 1987–2003 | Clinical stage | RP volume categorized in 5 groups: 1st (≤49), 2nd (50–99), 3rd (100–249), 4th (250–999), 5th (≥1000) and 2 groups: low (≤10), high (≥250) | Biochemical recurrence: Low risk (absolute difference between high and low, 95% CI): 2.5%, 1.7–4.0%; p < 0.001 Intermediate risk (absolute difference between high and low, 95% CI): 1.9%, 1.5–2.6%; p < 0.001 High risk (absolute difference between high and low, 95% CI): 1.3%, 1.0–1.6%; p = 0.02 |
| Prasad et al [56] | Retrospective | Medicare claims (n = 2072), 2003–2005 | Age, CCI, race, hospital region, surgical approach | Continuously coded | Rate of PLND (OR; 95% CI): 1.14; 1.10–1.19; p = 0.05 |
| Kattan et al [52] | Retrospective | Multi-institutional series (n = 7724), 1987–2003 | PSA, clinical stage, tumor grade | Continuously coded | Biochemical recurrence Preoperative risk: (concordance index): 0.767 with surgeon volume vs 0.764 without surgeon volume (p = 0.1) Postoperative risk: (concordance index): 0.812 with surgeon volume vs 0.811 without surgeon volume (p = 0.1) |
| Vickers et al [54] | Retrospective | Multi-institutional series (n = 4702), 1998–2007 | PSA, clinical stage, tumor grade | RP volume categorized in four groups: 1st (<50), 2nd (50–99), 3rd (100–249), 4th (≥250) | Biochemical recurrence (absolute risk difference, 95% CI): ≤10 vs ≥750 cases (8%, 4–12%; p = 0.005) |
| Choi et al [50] | Retrospective | SEER Medicare claims (n = 8831), 2003–2007 | Age, CCI, race, marital status, education, income, population density, clinical stage, tumor grade | RP volume categorized in 3 groups, according to surgical technique: MIRP low (≤17), medium (18–52), high (53–424) ORP low (≤11), medium (12–25), high (24–94) | Risk of adjuvant therapy MIRP low (7%), medium (4.7%), high (4.5%); p = 0.02 ORP low (7%), medium (6.8%), high (5.7%); p = 0.04 Prolonged length of stay MIRP low (2.3%), medium (1.9%), high (1.8%); p = 0.02 ORP low (3.6%), medium (3.3%), high (2.8%); p < 0.001 Blood transfusion MIRP low (23%), medium (21%), high (16%); p = 0.01 ORP low (3.3%), medium (2.0%), high (1.6%); p = 0.3 Postoperative complications MIRP low (22%), medium (21%), high (22%); p = 0.9 ORP low (26%), medium (21%), high (16%); p = 0.01 Stricture MIRP low (6.4%), medium (4.6%), high (5.4%); p = 0.5 ORP low (16%), medium (16%), high (9.7%); p < 0.001 Secondary therapy MIRP low (7.2%), medium (4.6%), high (4.8%); p = 0.01 ORP low (7.0%), medium (7.0%), high (5.8%); p = 0.1 |
| Lowrance et al [39] | Retrospective | SEER Medicare claims (n = 5923) | Age, CCI, race, location, marital status, income, PSA, clinical stage, pathologic stage, number of lymph nodes examined, lymph node involvement, Gleason score, year of diagnosis | Continuously coded | Prolonged length of stay (p < 0.001) Medical or surgical complications (p = 0.3) Urinary Complications (p < 0.05) |
| Vickers et al [60] | Retrospective | Single institutional series (n = 1910), 1999–2007 | Age, CCI, PSA, clinical stage, tumor grade, year of surgery | Continuously coded | 1-yr erectile and urinary function Probability of recovery: ≤25/yr (21%), ≥100/yr (47%); p = 0.005 |
| Vickers et al [48] | Retrospective | Multi-institutional series (n = 7765), 1987–2003 | PSA, clinical stage, tumor grade, year of surgery | RP volume categorized in 5 groups: 1st (<50), 2nd (50–99), 3rd (100–249), 4th (250–999), 5th (≥1000) | Positive surgical margins (relative risk difference, 95% CI): ≤10 vs ≥250/yr (1.59, 1.43–1.76); p = 0.02 |
| Secin et al [49] | Retrospective | Multi-institutional series (n = 8544), 1998–2007 | PSA, clinical stage | RP volume categorized in 4 groups: 1st (<50), 2nd (50–99), 3rd (100–249), 4th (250–1100) | Positive surgical margins (relative risk difference, 95% CI): ≤10 vs ≥ 250/yr (4.8; 1.5–8.5); p = 0.007 |
| Budäus et al [40] | Retrospective | Florida Hospital Inpatient Datafile (n = 2439), 2002–2008 | Age, CCI, race, year of surgery, hospital volume | RP volume categorized in 3 groups: low (≤15), intermediate (16–63), high (64–171) | Prolonged length of stay (OR, 95% CI): intermediate vs low (0.36; 0.27–0.50; p < 0.001), high vs low (0.29; 0.22–0.38; p < 0.001) |
| Budäus et al [63] | Retrospective | Florida Hospital Inpatient Datafile (n = 2666), 2002–2008 | Age, CCI, race, year of surgery | RP volume categorized in 3 groups: low (≤15), intermediate (16–63), high (64–171) | Total hospital charges (OR; 95% CI): intermediate vs low (0.41; 0.33–0.51; p < 0.001), high vs low (0.10; 0.06–0.10, p < 0.001) |
| Budäus et al [44] | Retrospective | Florida Hospital Inpatient Datafile (n = 2666), 2002–2008 | Age, CCI, race, year of surgery | RP volume categorized in 3 groups: low (≤16), intermediate (17–76), high (77–500/yr) | Complications (OR; 95% CI): intermediate vs low (0.45; 0.33–0.63; p < 0.001), high vs low (0.28; 0.19–0.41; p < 0.001) Transfusions (OR; 95% CI): intermediate vs low (0.26; 0.13–0.61; p < 0.001), high vs low (0.15; 0.10–0.39; p < 0.001) |
| Hu et al [58] | Retrospective | SEER Medicare claims (n = 5448), 2004–2006 | Age, CCI, race, risk groups, hospital region surgical approach | Continuously coded | Rate of PLND (OR; 95% CI): 1.008 (1.004–1.011); p < 0.001 |
| Vesey et al [24] | Retrospective | BAUS Section of Oncology Complex Operations Database | Age, CCI, PSA, clinical stage, tumor grade | Continuously coded | Intraoperative complications Postoperative complications Positive surgical margins p < 0.01 Biochemical recurrence OR: 0.98; p < 0.05 |
| Williams et al [51] | Retrospective | SEER Medicare claims (n = 42 47) | Age, CCI, race, PSA, clinical stage, tumor grade, surgical approach, hospital region, year of surgery | RP volume categorized in 4 groups: ORP low (≤7), intermediate (8–15), high (16–29), very high (≥30) MIRP low (≤14), intermediate (15–36), high (37–89), very high (≥90) | Positive surgical margins; p > 0.05 |
| Williams et al (2011) | Retrospective | SEER Medicare claims (n = 4247) | Age, CCI, race, marital status, education, income, region, population density, clinical stage, tumor grade, PSA, risk groups, year of surgery | RP volume categorized in 4 groups: ORP low (≤7), intermediate (8–15), high (16–29), very high (≥30) MIRP low (≤14), intermediate (15–36), high (37–89), very high (≥90) | Risk of adjuvant cancer therapy (HR; 95% CI): very high vs low (0.60; 0.46–0.78, p < 0.001). All other volume categories were p > 0.05 |
CCI = Charlson Comorbidity Index; CI = confidence interval; MIRP = minimally invasive radical prostatectomy; NIS = Nationwide Inpatient Sample; OR = odds ratio; ORP = open radical prostatectomy; PLND = pelvic lymph node dissection; PSA = prostate-specific antigen; RP = radical prostatectomy; SEER = Surveillance Epidemiology and End Results.
*
Displayed in chronological order.