Associations Between Hospital Volume and Outcomes of Robot-Assisted Radical Prostatectomy.

Robot-assisted radical prostatectomy (RARP) has become the predominant surgical modality to manage localized prostate cancer in the US. However, there are very few studies focusing on the associations between hospital volume and outcomes of RARP.

We identified RARPs for clinically localized (cT1-2N0M0) prostate cancer diagnosed between 2010 and 2014 in the National Cancer Database. We categorized annual average hospital RARP volume into very low, low, medium, high, and very high by most closely sorting final included patients into five equal-sized groups (quintiles). Outcomes included 30-day mortality, 90-day mortality, conversion (to open), prolonged length of stay (PLOS, >2 d), 30-day (unplanned) readmission, positive surgical margin (PSM), and lymph node dissection (LND) rates.

A total of 114,957 patients were included and hospital volume was categorized into very low (3-45 cases/year), low (46-72 cases/year), medium (73-113 cases/year), high (114-218 cases/year), and very high (≥219 cases/year). Overall 30-day mortality (0.12%), 90-day mortality (0.16%), and conversion rate (0.65%) were low. Multivariable logistic regressions showed that compared with very low volume group, higher hospital volume was associated with lower odds of conversion to open surgery (OR=0.23, p<0.001 for very high), pLOS (OR=0.25, p<0.001 for very high), 30-day readmission (OR=0.53, p<0.001 for very high), and PSM (OR=0.61, p<0.001 for very high). Higher hospital volume was also associated with higher odds of LND in the intermediate/high-risk cohort (OR=3.23, p<0.001 for very high).

Patients undergoing RARP at higher volume hospitals are likely to have improved perioperative and superior oncologic outcomes than lower volume hospitals.

The Journal of urology. 2019 Dec 17 [Epub ahead of print]

Leilei Xia, Colin D Sperling, Benjamin L Taylor, Ruchika Talwar, Raju R Chelluri, Jay D Raman, Daniel J Lee, David I Lee, Thomas J Guzzo

Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York., Division of Urology, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.