Impact of Hospital volume on postoperative outcomes after radical prostatectomy: A 5-Year nationwide database analysis.

Abstract

BACKGROUND\nHospital volume is considered to be a quality measure for outcomes after major oncological surgery. However, countrywide data are lacking for radical prostatectomy (RP).\n\n\nOBJECTIVE\nTo assess the impact of hospital volume on postoperative outcomes after RP performed using an open (ORP) versus a minimally invasive surgery (MIS, including pure and robot-assisted RP) approach.\n\n\nDESIGN, SETTING, AND PARTICIPANTS\nData for patients undergoing RP in France from 2014 to 2019 were extracted from the central database of the national health care system.\n\n\nOUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS\nPrimary endpoints were length of hospital stay (LOS), complications (measured as severity index [SI] scores), and hospital readmission rates at 30 and 90 d.\n\n\nRESULTS AND LIMITATIONS\nThe median annual hospital volume was 19 RPs (interquartile range 1-40) in the overall cohort. MIS was associated with better outcomes than ORP. Greater hospital volume was correlated with shorter LOS (p < 0.001), high SI scores (SI3: p < 0.001; SI4: p < 0.001), and 30-d (p < 0.001) and 90-d readmission rates (p < 0.001). Incidence rates for SI3 and SI4 scores, and 30-d and 90-d readmission were 12.8 %, 5.8 %, 29.8 %, and 35.4 % in very low-volume centres (<10 annual cases) compared with 8.1 %, 1.9 %, 18.1 %, and 23.9 %, respectively, in other centres (all p < 0.001). Hospital volume was an independent risk factor for all outcomes after taking into account age, lymph node dissection, year of surgery, and surgical approach (ORP vs MIS). The main limitation is the lack of post-RP oncological and functional data.\n\n\nCONCLUSIONS\nThis nationwide analysis of RP procedures shows a significant correlation between hospital volume and postoperative outcomes irrespective of the surgical approach. Very low case volume (<10 annual procedures per centre) is associated with the highest risk of complications, readmission, and prolonged LOS. Greater hospital volume is directly correlated with shorter LOS even beyond this threshold.\n\n\nPATIENT SUMMARY\nIn this study we analysed the French nationwide database for removal of the prostate for prostate cancer. We found that the number of these cases that a hospital carries out per year was associated with outcomes after surgery, with better outcomes for higher annual case numbers.