BJU Int. 2021 Jun 16. doi: 10.1111/bju.15516. Online ahead of print.
ABSTRACT
OBJECTIVES: To investigate volume-outcome relationships in robot-assisted radical prostatectomy for cancer using data from the Hospital Episodes Statistics (HES) database for England.
MATERIALS AND METHODS: Data for all adult, elective radical prostatectomies for cancer during the period January 2013-December 2018 (inclusive) were extracted from the HES database. HES records data on all National Health Service hospital admissions in England. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (laparoscopic, open or robot-assisted), length of hospital stay, emergency readmissions and deaths. Multilevel modelling was used to adjust for hierarchy and covariates.
RESULTS: Data were available for 35,629 radical prostatectomies (27,945 robot-assisted). The proportion of procedures conducted as robot-assisted surgery increased from 53.2% in 2013 to 92.6% in 2018. For robot-assisted surgery, there was a significant relationship between 90-day emergency hospital readmission (primary outcome) and trust volume (odds ratio for volume decrease of ten procedures 0.99 (95% confidence interval 0.99 to 1.00, p = 0.037) and surgeon volume (odds ratio for volume decrease of ten procedures 0.99 (95% confidence interval 0.99 to 1.00, p = 0.013) in the previous year. From lowest to highest volume category there was a decline in the adjusted proportion of patients readmitted as an emergency at 90 days from 10.6% (0-49 procedures) to 7.0% (≥ 300 procedures) for trusts and from 9.4% (0-9 procedures) to 8.3% (≥ 100 procedures) for surgeons. Length of stay was also significantly associated with surgeon and trust volume, although one year mortality was associated with neither.
CONCLUSIONS: There is evidence of a volume-outcome relationship for robot-assisted radical prostatectomy in England and minimising low volume surgery will improve patient outcomes. Nevertheless, the observed effect size was relatively modest, and stakeholders should be realistic when evaluating the likely impact of further centralisation at a population level.
PMID:34133832 | DOI:10.1111/bju.15516
