Higher hospital volume more important than surgeon experience in outcome of prostate cancer surgery

May 15, 2012

Older, sicker, high-risk patients who undergo one of the most common treatments for prostate cancer get better results in larger, busier hospitals, according to new research by Henry Ford Hospital.

In such cases, the same research showed the experience level of the surgeon doing the procedure mattered somewhat less than the setting.

The results, based on data gathered throughout the U.S., will be presented this week at the American Urological Association Annual Meeting in Atlanta.

It is both intuitive – "practice makes perfect" – and has been well known and accepted in the medical community, that both higher hospital volume (the number of occupied beds) and higher surgeon volume (the number of operations performed) lead to better surgical results.

But the new study is the first to test that conclusion in a head-to-head comparison of the two factors on radical prostatectomy (RP).

"There's a clear and distinct relation between surgeon and hospital volume and outcome – the more you do the better the results," says Quoc-Dien Trinh, M.D., a Fellow at Henry Ford Hospital's Vattikuti Urology Institute and lead author of the study.

"I think the novelty of this research is that there are not a lot of studies that have compared hospital to surgeon volume. When does hospital volume matter more, and when does surgeon volume?"

RP, in which the entire prostate gland and some of the surrounding tissue are surgically removed, is the most widely used treatment for prostate cancer, the second most common cancer in American men older than 45. The surgery is highly complex and the results can have serious effects on quality of life, including incontinence and erectile dysfunction.

Drawing on data from the National Cancer Institute's Surveillance, Epidemiology and End Results Program (SEER), the researchers identified 19,225 Medicare patients with who underwent RP from 1995 to 2005. Then, looking at the outcome for each patient within 30 days after surgery, they analyzed the effect of both hospital volume (HV) and surgeon volume (SV) in predicting complications, including blood transfusion, anastomotic stricture (scarring and narrowing of incision lines), long-term incontinence, and erectile dysfunction.

In each case, the results were adjusted for the patient's age, race, the presence of other disease or disorders, and marital and socioeconomic status, as well the hospital's surrounding population density, the surgical approach, and the seriousness of the cancer.

The study found:

  • Both higher HV and higher SV led to lower rates of overall complications.
  • HV and SV were each related to fewer respiratory and vascular complications.
  • Higher SV led to less need for blood transfusion.
  • Both HV and SV were associated with lower rates of anastomotic stricture, urinary incontinence, and erectile dysfunction.
Based on these findings and others, the researchers concluded "hospital volume matters more where it's about general delivery of care – for example, preventing complications and mortality," Dr. Trinh says. "That probably depends on the quality of the hospital's intensive care unit, the nursing staff, and other factors such as those, rather than on a specific surgeon's skill.

"But risk of recurrence probably depends on the skill of the surgeon to remove the cancer properly, not on how good the hospital is."

Overall, Dr. Trinh adds, "the main finding is that hospital volume matters more than surgeon volume with regard to 30-day complication rates, especially for older, sicker patients, those at higher risk of complications."

Explore further: Prostate cancer surgery better at teaching hospitals

Related Stories

Prostate cancer surgery better at teaching hospitals

November 7, 2011
Prostate cancer patients who undergo radical prostatectomy get better results at teaching hospitals than at non-academic medical institutions, according to the findings of an international study led by researchers at Henry ...

Fewer prostate cancer surgery complications found in teaching hospitals with fellowship programs

May 15, 2012
Patients who undergo radical surgery for prostate cancer may expect better results, on average, if they're treated in accredited teaching hospitals with residency programs, and better still if the hospitals also have medical ...

Fewer complications, better outcomes with robot-assisted prostate cancer surgery

April 24, 2012
Robot-assisted surgery is now both more common and far more successful than radical "open" surgery to treat prostate cancer in the United States, according to a new Henry Ford Hospital study published in the current issue ...

Safer kidney cancer surgery under-used for poorer, sicker Medicare, Medicaid patients

May 15, 2012
An increasingly common and safer type of surgery for kidney cancer is not as likely to be used for older, sicker and poorer patients who are uninsured or rely on Medicare or Medicaid for their health care, according to a ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.