Impact of hospital volume and surgeon volume on robot‐assisted partial nephrectomy outcomes: a multicentre study

Abstract

Objective To assess the impact of hospital volume ( HV ) and surgeon volume ( SV ) on perioperative outcomes of robot‐assisted partial nephrectomy ( RAPN ). Patients and Methods All consecutive patients who underwent a RAPN from 2009 to 2015, at 11 institutions, were included in a retrospective study. To evaluate the impact of HV , we divided RAPN into four quartiles according to the caseload per year: low HV (<20/year), moderate HV (20–44/year), high HV (45–70/year), and very high HV (>70/year). The SV was also divided into four quartiles: low SV (<7/year), moderate SV (7–14/year), high SV (15–30/year), and very high SV (>30/year). The primary endpoint was the Trifecta defined as the following combination: no complications, warm ischaemia time ( WIT ) <25 min, and negative surgical margins. Results In total, 1 222 RAPN were included. The mean ( sd ) caseload per hospital per year was 44.9 (26.7) RAPN s and the mean ( sd ) caseload per surgeon per year was 19.2 (14.9) RAPN s. The Trifecta achievement rate increased significantly with SV (69.9% vs 72.8% vs 73% vs 86.1%; P < 0.001) and HV (60.3% vs 72.3% vs 86.2% vs 82.4%; P < 0.001). The positive surgical margins ( PSM ) rate ( P = 0.02), length of hospital stay ( LOS ; P < 0.001), WIT ( P < 0.001), and operative time ( P < 0.001), all decreased significantly with increasing SV . The PSM rate ( P = 0.02), LOS ( P < 0.001), WIT ( P < 0.001), operative time ( P < 0.001), and major complications rate ( P = 0.01), all decreased significantly with increasing HV . In multivariate analysis adjusting for HV and SV (model 3), HV remained the main predictive factor of Trifecta achievement (odds ratio [ OR ] 3.70 for very high vs low HV ; P < 0.001), whereas SV was not associated with Trifecta achievement ( OR 1.58 for very high vs low SV ; P = 0.34). Conclusion In this multicentre study HV and SV both greatly influenced RAPN perioperative outcomes, but HV appeared to have a greater impact than SV .