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Variations in morbidity after radical prostatectomy.

Colin B Begg1, Elyn R Riedel, Peter B Bach

  • 1Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York 10021, USA. beggc@mskcc.org

The New England Journal of Medicine
|April 12, 2002
PubMed
Summary
This summary is machine-generated.

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Radical prostatectomy outcomes improve with higher hospital and surgeon volume. High-volume care reduces postoperative and late urinary complications for prostate cancer patients.

Area of Science:

  • Urology
  • Surgical Oncology
  • Health Services Research

Background:

  • Variations in cancer surgery outcomes exist across hospitals and surgeons.
  • Morbidity after radical prostatectomy for prostate cancer requires examination.

Purpose of the Study:

  • To investigate variations in morbidity after radical prostatectomy.
  • To analyze the relationship between hospital/surgeon volume and patient outcomes.

Main Methods:

  • Utilized Surveillance, Epidemiology, and End Results-Medicare data (11,522 patients, 1992-1996).
  • Assessed postoperative complications, late urinary complications (31-365 days), and long-term incontinence (>1 year).
  • Correlated outcomes with hospital and surgeon procedure volume.

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Main Results:

  • Neither hospital nor surgeon volume impacted surgery-related death rates.
  • Higher hospital and surgeon volume correlated with reduced postoperative complications (27% vs. 32% and 26% vs. 32%, respectively).
  • Similar trends observed for late urinary complications; continence preservation results were less definitive. Significant surgeon-to-surgeon outcome variation noted.

Conclusions:

  • Performing radical prostatectomy in high-volume hospitals and by high-volume surgeons significantly reduces postoperative and late urinary complications.
  • Volume appears to be a critical factor in optimizing surgical outcomes for prostate cancer.