Leapfrog volume thresholds and perioperative complications after radical prostatectomy

Abstract

Background: The authors explored the effect of Leapfrog volume thresholds (LVTs) on 5 short-term radical prostatectomy (RP) outcomes.

Methods: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), the authors focused on RPs performed within the 7 most contemporary years (2001-2007). They tested rates of in-hospital mortality, intraoperative complications, postoperative complications, and blood transfusions as well as the mean length of stay (LOS), stratified according to the number of LVTs that were met. Multivariable regression analyses were adjusted further for potential confounders.

Results: Overall, 36.2%, 17.3%, 14.9%, 15.7%, 12.9%, and 3% of RPs were performed at institutions that reached 0 LVT, 1 LVT, 2 LVTs, 3 LVTs, 4 LVTs, and 5 LVTs, respectively. Relative to patients who underwent RP at institutions that reached 0 LVTs, patients who underwent RP at institutions that reached 5 LVTs had fewer comorbidities, were younger, were more likely to hold private insurance, and were more likely to undergo concomitant pelvic lymphadenectomy (all P < .001). In multivariable analyses adjusted for hospital volume (HV), age, race, year of surgery, Charlson Comorbidity Index, hospital region and location, pelvic lymphadenectomy, and insurance status, LVT status was related inversely to LOS and the likelihood of receiving blood transfusions (both P < .001).

Conclusions: The current results indicated that LVTs can provide a highly accurate prediction of the probability of 2 important, detrimental, short-term outcomes after RP, even after accounting for HV. The benefit at institutions that meet LVTs may exceed that at other institutions when short-term RP outcomes are considered. This observation should be taken into consideration when treatment decisions are made, especially because most RPs were performed at institutions that did not meet any LVTs.