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Guijarro A, Castro A, Hernández V, de la Peña E, Sánchez-Rosendo L, Jiménez E, Pérez-Férnandez E, Llorente C. Population based study of morbidity and mortality rates associated to radical prostatectomy cases in Spain. Actas Urol Esp 2022; 46:619-628. [PMID: 36280035 DOI: 10.1016/j.acuroe.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is no population-based study that accounts for the number of radical prostatectomies (RP) carried out in Spain, nor regarding the morbidity and mortality of this intervention. Our objective is to study the morbidity and mortality of RP in Spain from 2011 to 2015 and to evaluate the geographic variation. MATERIAL AND METHODS We designed a retrospective observational study of all patients submitted to RP in Spain during five consecutive years (2011-2015). The data was extracted from the «Conjunto Mínimo Básico de Datos» (CMBD). We have evaluated geographic variations in terms of morbidity and hospital stay, and the impact of the mean annual surgical volume for each center on these variables. RESULTS Between 2011-2015, a total of 37,725 RPs were performed in 221 Spanish public hospitals. The mean age of the series was 63.9±3.23 years. Of all RPs, 50% were performed through an open approach, and 43.4% have been operated on in hospitals with <500 beds. We observed an important variability in the distribution of the cases operated on in the different regions. The regions that perform more RPs are Andalusia, Catalonia, Galicia, and Madrid. Our study shows a complication rate of 8.6%, with hemorrhage and the need for transfusion being the most frequent (5.3 and 4%, respectively). There are significant differences in bleeding rates and hospital stay among regions, which are maintained after adjusting for patient characteristics and type of hospital. When studying the annual surgical volume of each hospital, we find that the impact on the rate of hemorrhage or transfusion is linear; however, hospital stay remains stable at around 5 days from 60 RPs/year. CONCLUSIONS In national terms, morbidity and mortality rates after RP are comparable to those described in the literature. This study reveals a clear dispersion in the hospitals that carry out this intervention, showing clear differences in terms of morbidity and hospital stay between the different regions.
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Affiliation(s)
- A Guijarro
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - A Castro
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - V Hernández
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - E de la Peña
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - L Sánchez-Rosendo
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - E Jiménez
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - E Pérez-Férnandez
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - C Llorente
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Guijarro A, Castro A, Hernández V, de la Peña E, Sánchez-Rosendo L, Jiménez E, Pérez-Férnandez E, Llorente C. Estudio poblacional de casuística y morbimortalidad de la prostatectomía radical en España. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3
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Mukkala AN, Song JB, Lee M, Boasie A, Irish J, Finelli A, Wei AC. A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer. Can Urol Assoc J 2021; 15:E531-E544. [PMID: 33750517 PMCID: PMC8525525 DOI: 10.5489/cuaj.6931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Unplanned visits (UPV) - re-admissions and emergency room (ER) visits - are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP to inform evidence-based quality improvement (QI) initiatives. METHODS A systematic review was performed for studies from 2000-2020 using keywords: "re-admission," "emergency room/department," "unplanned visit," and "prostatectomy." Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. RESULTS Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (approximately 5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6-24%; re-admissions range 0-56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications, such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common re-admission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urine-related issues, such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: open RP, lymph node dissection, Charlson comorbidity index ≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls, with odds ratio 0.62 (95% confidence interval 0.46-0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. CONCLUSIONS Twenty years of international, retrospective experience suggests UPV after RP are often related to GU complications and infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have the potential to reduce UPV after RP.
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Affiliation(s)
- Avinash N. Mukkala
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jasmine B. Song
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Lee
- Regional Cancer Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alexandra Boasie
- Surgery and Critical Care Program, University Health Network, Toronto, ON, Canada
| | - Jonathan Irish
- Surgical Oncology Program, Cancer Care Ontario, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alice C. Wei
- Surgical Oncology Program, Cancer Care Ontario, Toronto, ON, Canada
- Weill-Cornell School of Medicine, Cornell University, New York, NY, United States
- Sloan Kettering Cancer Center, New York, NY, United States
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Rangel FP, Auler JOC, Carmona MJC, Cordeiro MD, Nahas WC, Coelho RF, Simões CM. Opioids and premature biochemical recurrence of prostate cancer: a randomised prospective clinical trial. Br J Anaesth 2021; 126:931-939. [PMID: 33712224 DOI: 10.1016/j.bja.2021.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prostate cancer is one of the most prevalent neoplasms in male patients, and surgery is the main treatment. Opioids can have immune modulating effects, but their relation to cancer recurrence is unclear. We evaluated whether opioids used during prostatectomy can affect biochemical recurrence-free survival. METHODS We randomised 146 patients with prostate cancer scheduled for prostatectomy into opioid-free anaesthesia or opioid-based anaesthesia groups. Baseline characteristics, perioperative data, and level of prostate-specific antigen every 6 months for 2 yr after surgery were recorded. Prostate-specific antigen >0.2 ng ml-1 was considered biochemical recurrence. A survival analysis compared time with biochemical recurrence between the groups, and a Cox regression was modelled to evaluate which variables affect biochemical recurrence-free survival. RESULTS We observed 31 biochemical recurrence events: 17 in the opioid-free anaesthesia group and 14 in the opioid-based anaesthesia group. Biochemical recurrence-free survival was not statistically different between groups (P=0.54). Cox regression revealed that biochemical recurrence-free survival was shorter in cases of obesity (hazard ratio [HR] 1.63, confidence interval [CI] 0.16-3.10; p=0.03), high D'Amico risk (HR 1.58, CI 0.35-2.81; P=0.012), laparoscopic surgery (HR 1.6, CI 0.38-2.84; P=0.01), stage 3 tumour pathology (HR 1.60, CI 0.20-299) and N1 status (HR 1.34, CI 0.28-2.41), and positive surgical margins (HR 1.37, CI 0.50-2.24; P=0.002). The anaesthesia technique did not affect time to biochemical recurrence (HR -1.03, CI -2.65-0.49; P=0.18). CONCLUSIONS Intraoperative opioid use did not modify biochemical recurrence rates and biochemical recurrence-free survival in patients with intermediate and high D'Amico risk prostate cancer undergoing radical prostatectomy. CLINICAL TRIAL REGISTRATION NCT03212456.
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Affiliation(s)
- Felipe P Rangel
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Serviços Médicos de Anestesia (SMA), São Paulo, Brazil.
| | - José O C Auler
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Department of Anaesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Anaesthesia Department, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Maria J C Carmona
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Department of Anaesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Mauricio D Cordeiro
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - William C Nahas
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Rafael F Coelho
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Claudia M Simões
- Division of Anaesthesia, Hospital das Clínicas da Faculdade de Medicina (HCFMUSP) da Universidade de São Paulo, São Paulo, Brazil; Serviços Médicos de Anestesia (SMA), São Paulo, Brazil; Anaesthesia Department, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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Smith-Palmer J, Takizawa C, Valentine W. Literature review of the burden of prostate cancer in Germany, France, the United Kingdom and Canada. BMC Urol 2019; 19:19. [PMID: 30885200 PMCID: PMC6421711 DOI: 10.1186/s12894-019-0448-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Prostate cancer is the most frequently reported cancer in males in Europe, and is associated with substantial morbidity and mortality. The aim of the current review was to characterize the clinical, economic and humanistic burden of disease associated with prostate cancer in France, Germany, the UK and Canada. METHODS Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases to identify studies reporting incidence and/or mortality rates, costs and health state utilities associated with prostate cancer in the settings of interest. For inclusion, studies were required to be published in English in full-text form from 2006 onwards. RESULTS Incidence studies showed that in all settings the incidence of prostate cancer has increased substantially over the past two decades, driven in part by increased uptake of prostate specific antigen (PSA) screening leading to earlier identification of tumors, but which has also led to over-treatment, compounding the economic burden of disease. Mortality rates have declined over the same time frame, driven by earlier detection and improvements in treatment. Both prostate cancer itself, as well as treatment and treatment-related complications, are associated with reduced quality of life. CONCLUSIONS Prostate cancer is associated with a significant clinical and economic burden, whilst earlier detection and aggressive treatment is associated with improved survival, over-treatment of men with indolent tumors compounds the already significant burden of disease and treatment can lead to long-term side effects including impotence and impaired urinary and/or bowel function. There is currently an unmet clinical need for diagnostic and/or prognostic tools that facilitate personalized prostate cancer treatment, and potentially reduce the clinical, economic and humanistic burden of invasive cancer treatment.
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Affiliation(s)
- J. Smith-Palmer
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland
| | - C. Takizawa
- Genomic Health International, Geneva, Switzerland
| | - W. Valentine
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland
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Aggarwal AK, Sujenthiran A, Lewis D, Walker K, Cathcart P, Clarke N, Sullivan R, van der Meulen JH. Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population-based study. Cancer 2019; 125:1898-1907. [PMID: 30707779 DOI: 10.1002/cncr.31987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Policies that encourage patient choice and hospital competition have been introduced across several countries with the purpose of improving the quality of health care services. The objective of the current national cohort study was to analyze the correlation between choice and competition on outcomes after cancer surgery using prostate cancer as a case study. METHODS The analyses included all men who underwent prostate cancer surgery in the United Kingdom between 2008 and 2011 (n = 12,925). Multilevel logistic regression was used to assess the effect of a radical prostatectomy center being located in a competitive environment (based on the number of centers within a threshold distance) and being a successful competitor (based on the ability to attract patients from other hospitals) on 3 patient-level outcomes: postoperative length of hospital stay >3 days, 30-day emergency readmissions, and 2-year urinary complications. RESULTS With adjustment for patient characteristics, men who underwent surgery in centers located in a stronger competitive environment were less likely to have a 30-day emergency readmission, irrespective of the type or volume of procedures performed at each center (odds ratio, 0.46; 95% confidence interval, 0.36-0.60; P = .005). Men who received treatment at centers that were successful competitors were less likely to have a length of hospital stay >3 days (odds ratio, 0.49; 95% confidence interval, 0.25-0.94; P = .02). CONCLUSIONS The current results suggest for the first time that hospital competition improves short-term outcomes after prostate cancer surgery. Further evaluation of the potential role of patient choice and hospital competition is required to inform health service design in contrast to the role of top-down-driven approaches, which have focused on centralization of services.
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Affiliation(s)
- Ajay K Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Clinical Oncology, Guy's and St Thomas' National Health Service Trust, London, United Kingdom
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Daniel Lewis
- Department of Social and Environment Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kate Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' National Health Service Trust, London, United Kingdom
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Jan H van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
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Coelho RF, Cordeiro MD, Padovani GP, Localli R, Fonseca L, Pontes J, Guglielmetti GB, Srougi M, Nahas WC. Predictive factors for prolonged hospital stay after retropubic radical prostatectomy in a high-volume teaching center. Int Braz J Urol 2018; 44:1089-1105. [PMID: 30325597 PMCID: PMC6442193 DOI: 10.1590/s1677-5538.ibju.2017.0339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/12/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution, and analyze the rate of unplanned visits to the office, emergency care, hospital readmissions and perioperative complications rates. Materials and Methods: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution between January/2010 - January/2012. A logistic regression model including preoperative variables was initially built in order to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Results: 1011 patients underwent RRP at our institution were evaluated. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICC (OR. 1.40 p=0.003), age (OR 1.050 p<0.001), ASA score of 3 (OR. 3.260 p<0.001), prostate volume on USG-TR (OR, 1.005 p=0.038) and African-American race (OR 2.235 p=0.004); among intra and postoperative factors, operative time (OR 1.007 p=0.022) and the presence of any complications (OR 2.013 p=0.009) or major complications (OR 2.357 p=0.01) were also correlated independently with prolonged hospital stay. The complication rate was 14.5%. Conclusions: The independent predictors of prolonged hospitalization among preoperative variables were CCI, age, ASA score of 3, prostate volume on USG-TR and African-American race; amongst intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay.
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Affiliation(s)
- Rafael F Coelho
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Mauricio D Cordeiro
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Guilherme P Padovani
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Rafael Localli
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Limirio Fonseca
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - José Pontes
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Giuliano B Guglielmetti
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - William Carlos Nahas
- Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Leow JJ, Leong EK, Serrell EC, Chang SL, Gruen RL, Png KS, Beaule LT, Trinh QD, Menon MM, Sammon JD. Systematic Review of the Volume-Outcome Relationship for Radical Prostatectomy. Eur Urol Focus 2017; 4:775-789. [PMID: 28753874 DOI: 10.1016/j.euf.2017.03.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Radical prostatectomy (RP) is one of the most complex urological procedures performed. Higher surgical volume has been found previously to be associated with better patient outcomes and reduced costs to the health care system. This has resulted in some regionalization of care toward high-volume facilities and providers; however, the preponderance of RPs is still performed at low-volume institutions. OBJECTIVE To provide an updated systematic review of the association of hospital and surgeon volume on patient and system outcomes after RP, including robot-assisted RP. EVIDENCE ACQUISITION A systematic review of literature was undertaken, searching PubMed (1959-2016) for original articles. Selection criteria included RP, hospital and/or surgeon volumes as predictor variables, categorization of hospital and/or surgeon volumes, and measurable end points. EVIDENCE SYNTHESIS Overall 49 publications fulfilled the inclusion criteria. Most of the studies demonstrated that higher-volume surgeries are associated with better outcomes including reduced mortality, morbidity, postoperative complications, length of stay, readmission, and cost-associated factors. The volume-outcome relationship is maintained in robotic surgery. Eleven studies assessed hospital and surgeon volume simultaneously, and findings reflect that neither is an independent predictor variable affecting outcomes. The studies varied in how volume cutoffs were categorized as well as how the volume-outcome relationship was methodologically evaluated. CONCLUSIONS Contemporary evidence continues to support the relationship between high-volume surgeries with improved RP outcomes. Recent studies demonstrate that the volume-outcome relationship applies to robot-assisted RP and may be applied for potential cost savings in health care. An increase in the number of international studies suggests reproducibility of the association. Although regionalization of surgical care remains a contentious issue, there is an increasing body of evidence that short-term outcomes are improved at high-volume centers for RP. PATIENT SUMMARY This systematic review of the latest literature found that higher surgical volume was associated with improved outcomes for radical prostatectomy.
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Affiliation(s)
- Jeffrey J Leow
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Eugene K Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore
| | | | - Steven L Chang
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell L Gruen
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore
| | - Keng Siang Png
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Lisa T Beaule
- Tufts University School of Medicine, Boston, MA, USA; Division of Urology, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mani M Menon
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- Tufts University School of Medicine, Boston, MA, USA; Division of Urology, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA.
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9
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Møller H, Riaz SP, Holmberg L, Jakobsen E, Lagergren J, Page R, Peake MD, Pearce N, Purushotham A, Sullivan R, Vedsted P, Luchtenborg M. High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England. Eur J Cancer 2016; 64:32-43. [PMID: 27328450 DOI: 10.1016/j.ejca.2016.05.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
Abstract
It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset for this analysis was based on cancer registration and hospital discharge data and comprised information on 15,738 non-small-cell lung cancer patients resident and diagnosed in England in 2006-2010 and treated by surgical resection. The number of lung cancer resections was computed for each hospital in each calendar year, and patients were assigned to a hospital volume quintile on the basis of the volume of their hospital. Hospitals with large lung cancer surgical resection volumes were less restrictive in their selection of patients for surgical management and provided a higher resection rate to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 d and 3% after 90 d. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 d than patients from the lowest quintile. Variations in outcomes were generally small, but in the same direction, with consistently better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access.
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Affiliation(s)
- Henrik Møller
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK; Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK; Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
| | - Sharma P Riaz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
| | - Lars Holmberg
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - Erik Jakobsen
- The Danish Lung Cancer Registry, Department of Thoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Jesper Lagergren
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Department of Molecular Medicine and Surgery (MMK), K1, Upper Gastrointestinal Research, Övre gastrointestinal forskning, NS 67, Institutionen för molekylär medicin och kirurgi, Karolinska Institutet, 171 76 Stockholm, Sweden.
| | - Richard Page
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.
| | - Michael D Peake
- Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK.
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Arnie Purushotham
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - Richard Sullivan
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - Peter Vedsted
- Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
| | - Margreet Luchtenborg
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK.
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10
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Zhang Y, Lee SYD, Gilleskie DB, Sun Y, Padakandla A, Jacobs BL, Montgomery JS, Montie JE, Wei JT, Hollenbeck BK. A Generalized Assessment of the Impact of Regionalization and Provider Learning on Patient Outcomes. Med Decis Making 2015; 36:990-8. [PMID: 26169752 DOI: 10.1177/0272989x15593282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/30/2015] [Indexed: 11/16/2022]
Abstract
We present a generalized model to assess the impact of regionalization on patient care outcomes in the presence of heterogeneity in provider learning. The model characterizes best regionalization policies as optimal allocations of patients across providers with heterogeneous learning abilities. We explore issues that arise when solving for best regionalization, which depends on statistically estimated provider learning curves. We explain how to maintain the problem's tractability and reformulate it into a binary integer program problem to improve solvability. Using our model, best regionalization solutions can be computed within reasonable time using current-day computers. We apply the model to minimally invasive radical prostatectomy and estimate that, in comparison to current care delivery, within-state regionalization can shorten length of stay by at least 40.8%.
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Affiliation(s)
- Yun Zhang
- University of Michigan Health System, Ann Arbor, MI (YZ)
| | - Shoou-Yih D Lee
- University of Michigan School of Public Health, Ann Arbor, MI (S-YDL)
| | - Donna B Gilleskie
- University of Michigan Health System, Ann Arbor, MI (YZ),University of North Carolina at Chapel Hill, Chapel Hill, NC (DBG)
| | | | - Arun Padakandla
- University of Michigan, Ann Arbor, MI (AP, JSM, JEM, JTW, BKH)
| | | | | | - James E Montie
- University of Michigan, Ann Arbor, MI (AP, JSM, JEM, JTW, BKH)
| | - John T Wei
- University of Michigan Health System, Ann Arbor, MI (YZ),University of Michigan, Ann Arbor, MI (AP, JSM, JEM, JTW, BKH)
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11
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Novara G, Ficarra V, Zattoni F, Fedeli U. Recourse to radical prostatectomy and associated short-term outcomes in Italy: a country-wide study over the last decade. BJU Int 2015; 116:862-7. [DOI: 10.1111/bju.13000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology; Urology Clinic; University of Padova; Padova Italy
| | - Vincenzo Ficarra
- Department of Experimental and Clinical Medical Sciences; Urologic Clinic; University of Udine; Udine Italy
| | - Filiberto Zattoni
- Department of Surgery, Oncology, and Gastroenterology; Urology Clinic; University of Padova; Padova Italy
| | - Ugo Fedeli
- Epidemiological Department; Veneto Region Italy
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