The impact of surgical experience on total hospital charges for minimally invasive prostatectomy: a population‐based study

• Published in: BJU international 2011-09, Vol.108 (6), p.888-893
• Main Authors: Budäus, Lars, Abdollah, Firas, Sun, Maxine, Johal, Rupinder, Morgan, Monica, Thuret, Rodolphe, Zorn, Kevin C., Lughezzani, Giovanni, Isbarn, Hendrik, Haese, Alexander, Shariat, Shahrokh F., Montorsi, Francesco, Perrotte, Paul, Graefen, Markus, Karakiewicz, Pierre I.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Clinical Competence - economics; Clinical Competence - standards; Florida; Hospital Charges; Hospitals, Urban - economics; Humans; Length of Stay - economics; Male; Medical sciences; Middle Aged; minimally invasive radical prostatectomy; Minimally Invasive Surgical Procedures - economics; Nephrology. Urinary tract diseases; outcome‐volume relationship; Prostatectomy - economics; Prostatectomy - methods; Prostatectomy - standards; Prostatic Neoplasms - economics; Prostatic Neoplasms - surgery; surgical volume; total hospital charges; Urology - economics; Urology - standards; Workload - economics
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09906.x

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Minimally invasive radical prostatectomy (MIRP) for the treatment of localized prostate cancer has rapidly gained increasing popularity over time. The current report highlights the importance of high surgical experience in regards to lowering MIRP hospital charges. OBJECTIVE • To evaluate the relationship between surgical volume (SV) and total hospital charges in patients undergoing minimally invasive radical prostatectomy (MIRP) for treatment of localized prostate cancer. PATIENTS AND METHODS • Within the Florida Hospital Inpatient Datafile, 2666 men who were treated with MIRP for prostate cancer between 2002–2008 were identified. • The SV was defined in two ways: annual caseload (AC) and each surgeons experience (SE) defined as the total number of procedures performed since entering the study until the time of each MIRP. RESULTS • The mean and median charges were respectively 38 852 and 31 511 US Dollars. AC ranged from 1–171 and SE varied from 1–500. Overall, 75.7 to 94% of surgeons were in the lowest AC tertile and 27 to 66% of patients were operated by low AC tertile surgeons. • After stratification according to AC tertiles, median charges were 41 564; 33 395 and 26 608 US Dollar for respectively low intermediate and high AC tertile categories. • Multivariable logistic regression models with generalized estimating equations revealed that the probability of charges above the median was reduced by respectively 38 and 68% in patients operated by intermediate SE (17–76 MIRPs) or high SE tertile (≥77 MIRPs) surgeons vs. low SE tertile (≤16 MIRPs) surgeons. CONCLUSIONS • High surgical experience reduces MIRP total hospital charges. • Despite this observation, even in 2008, 82% of MIRP surgeons were in the lowest AC tertile and contributed to 32% of all MIRPs.