730 THE EFFECT OF MINIMALLY INVASIVE AND OPEN RADICAL PROSTATECTOMY SURGEON VOLUME ON OUTCOMES

摘要

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy I1 Apr 2010730 THE EFFECT OF MINIMALLY INVASIVE AND OPEN RADICAL PROSTATECTOMY SURGEON VOLUME ON OUTCOMES Fernando Carvas, Wesley Choi, Sandip Prasad, Xiangmei Gu, Stuart Lipsitz, Anthony D'Amico, Lei Yin, Marcos Freire, Aaron Weinberg, and Jim Hu Fernando CarvasFernando Carvas , Wesley ChoiWesley Choi , Sandip PrasadSandip Prasad , Xiangmei GuXiangmei Gu , Stuart LipsitzStuart Lipsitz , Anthony D'AmicoAnthony D'Amico , Lei YinLei Yin , Marcos FreireMarcos Freire , Aaron WeinbergAaron Weinberg , and Jim HuJim Hu View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1218AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about the effect of minimally invasive radical prostatectomy (MIRP) surgeon volume on outcomes, and how volume-outcome effects for MIRP and open radical prostatectomy (ORP) differ. METHODS Using SEER Medicare linked data from 2003-2007, we identified 8,831 men ≥65 years who underwent either MIRP or ORP by 1,457 surgeons. We stratified surgeon volume into tertiles, and compared postoperative 30-day outcomes, rate of anastomotic stricture, incontinence and erectile dysfunction ≥18 months, and use of additional cancer therapies (radiation and hormonal therapy). We used weighted propensity score methods to adjust for observed differences in socio-demographics and tumor characteristics. RESULTS Men undergoing MIRP with high and medium vs. low volume surgeons were less likely to be incontinent (15% and 13.9% vs. 23.1%, p=0.039) or require additional cancer therapies (4.5% and 4.7%. vs. 7%, p=.020). Similarly, patients of high vs. medium and low volume ORP surgeons were less likely to be incontinent (9.4% vs. 11.3% and 13.3%, p<0.001) or require additional cancer therapy (5.7% vs. 6.8% and 7.1%, p=0.044). Men undergoing ORP with high vs. medium and low volume surgeons experienced fewer transfusions (15.4% vs. 21.3% and 22.7%, p=0.017), shorter lengths of stay (2.9 vs. 3.3 and 3.6 days, p<0.001), fewer 30-day complications (18.4% vs. 25.6% and 25.7%, p<0.001), and anastomotic strictures (10.1% vs. 15.6% and 16.3%, p=0.003). CONCLUSIONS For both ORP and MIRP, patients of higher volume surgeons were less likely to experience incontinence or require additional cancer therapy. However, while patients of high volume ORP surgeons experienced fewer blood transfusions, shorter length of stay, fewer 30-day complications, and anastomotic strictures, MIRP surgeon volume did not affect these peri-operative outcomes. Inherent advantages of MIRP such as magnification, pneumoperitoneum, and less blood loss may allow lower volume MIRP surgeons to achieve similar peri-operative outcomes with higher volume ones. Boston, MA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e285 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando Carvas More articles by this author Wesley Choi More articles by this author Sandip Prasad More articles by this author Xiangmei Gu More articles by this author Stuart Lipsitz More articles by this author Anthony D'Amico More articles by this author Lei Yin More articles by this author Marcos Freire More articles by this author Aaron Weinberg More articles by this author Jim Hu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...