The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy

doi:10.1016/j.urolonc.2012.10.008

. 2014 Jan;32(1):29.e13-20.

doi: 10.1016/j.urolonc.2012.10.008. Epub 2013 Mar 1.

The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy

Affiliations

¹ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: trinh.qd@gmail.com.
² Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
³ Department of Urology, Mayo Clinic, Rochester, MN, USA.
⁴ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
⁵ Department of Urology, Georgetown University Hospital, Washington, DC.
⁶ Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA.
⁷ Department of Urology, Weill Medical College of Cornell University, New York, NY.
⁸ Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.

PMID: 23453659
PMCID: PMC4201949
DOI: 10.1016/j.urolonc.2012.10.008

The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy

Quoc-Dien Trinh et al. Urol Oncol. 2014 Jan.

. 2014 Jan;32(1):29.e13-20.

doi: 10.1016/j.urolonc.2012.10.008. Epub 2013 Mar 1.

Authors

Affiliations

¹ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: trinh.qd@gmail.com.
² Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
³ Department of Urology, Mayo Clinic, Rochester, MN, USA.
⁴ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
⁵ Department of Urology, Georgetown University Hospital, Washington, DC.
⁶ Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA.
⁷ Department of Urology, Weill Medical College of Cornell University, New York, NY.
⁸ Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.

PMID: 23453659
PMCID: PMC4201949
DOI: 10.1016/j.urolonc.2012.10.008

Abstract

Objectives: Although high-volume hospitals have been associated with improved outcomes for radical prostatectomy (RP), the association of residency or fellowship teaching institutions or both and this volume-outcome relationship remains poorly described. We examine the effect of teaching status and hospital volume on perioperative RP outcomes.

Methods and materials: Within the Nationwide Inpatient Sample, we focused on RPs performed between 2003 and 2007. We tested the rates of prolonged length of stay beyond the median of 3 days, in-hospital mortality, and intraoperative and postoperative complications, stratified according to teaching status. Multivariable logistic regression analyses further adjusted for confounding factors.

Results: Overall, 47,100 eligible RPs were identified. Of these, 19,193 cases were performed at non-teaching institutions, 24,006 at residency teaching institutions, and 3,901 at fellowship teaching institutions. Relative to patients treated at non-teaching institutions, patients treated at fellowship teaching institutions were healthier and more likely to hold private insurance. In multivariable analyses, patients treated at residency (OR = 0.92, P = 0.015) and fellowship (OR = 0.82, P = 0.011) teaching institutions were less likely to experience a postoperative complication than patients treated at non-teaching institutions. Patients treated at residency (OR = 0.73, P<0.001) and fellowship (OR = 0.91, P = 0.045) teaching institutions were less likely to experience a prolonged length of stay.

Conclusions: More favorable postoperative complication profile and shorter length of stay should be expected at residency and fellowship teaching institutions following RP. Moreover, postoperative complication rates were lower at fellowship teaching than at residency teaching institutions, despite adjustment for potential confounders.

Keywords: Complication; Fellowship; Prostatectomy; Prostatic neoplasms; Residency; Teaching.

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Conflict of interest statement

Disclosure: Nothing to disclose.

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References

1. Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28:1117–23. - PMC - PubMed
1. Budaus L, Abdollah F, Sun M, et al. Annual surgical caseload and open radical prostatectomy outcomes: improving temporal trends. J Urol. 2010;184:2285–90. - PubMed
1. Barocas DA, Mitchell R, Chang SS, et al. Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol. 2010;28:243–50. - PubMed
1. Allison JJ, Kiefe CI, Weissman NW, et al. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000;284:1256–62. - PubMed
1. Ayanian JZ, Weissman JS, Chasan-Taber S, et al. Quality of care for two common illnesses in teaching and nonteaching hospitals. Health Aff (Millwood) 1998;17:194–205. - PubMed

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[1] Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28:1117–23. - PMC - PubMed

[2] Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28:1117–23. - PMC - PubMed

[3] Budaus L, Abdollah F, Sun M, et al. Annual surgical caseload and open radical prostatectomy outcomes: improving temporal trends. J Urol. 2010;184:2285–90. - PubMed

[4] Budaus L, Abdollah F, Sun M, et al. Annual surgical caseload and open radical prostatectomy outcomes: improving temporal trends. J Urol. 2010;184:2285–90. - PubMed

[5] Barocas DA, Mitchell R, Chang SS, et al. Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol. 2010;28:243–50. - PubMed

[6] Barocas DA, Mitchell R, Chang SS, et al. Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol. 2010;28:243–50. - PubMed

[7] Allison JJ, Kiefe CI, Weissman NW, et al. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000;284:1256–62. - PubMed

[8] Allison JJ, Kiefe CI, Weissman NW, et al. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000;284:1256–62. - PubMed

[9] Ayanian JZ, Weissman JS, Chasan-Taber S, et al. Quality of care for two common illnesses in teaching and nonteaching hospitals. Health Aff (Millwood) 1998;17:194–205. - PubMed

[10] Ayanian JZ, Weissman JS, Chasan-Taber S, et al. Quality of care for two common illnesses in teaching and nonteaching hospitals. Health Aff (Millwood) 1998;17:194–205. - PubMed

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The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy

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The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy

Authors

Affiliations

Abstract

Conflict of interest statement

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Grants and funding

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Medical