Seventy percent of hospitals offering robot-assisted radical prostatectomy averaged one or fewer cases per week, while hospitals with a higher volume of cases offered lower costs and fewer complications, according to a recent study.
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In a retrospective analysis of the data from the Nationwide Inpatient Sample, Gershman et al report that a substantial number of robotic prostatectomy procedures are performed at hospitals with fewer than 30 cases per year. In order to study the impact of case volume on perioperative outcomes, they divided the hospital case volume between January 2009 and December 2011 into quartiles: very low (12 or fewer cases), low (13 to 30), medium (31 to 66), and high (67 to 820).
The authors, who published their findings in the Journal of Urology (2017; 198:92-9), analyzed the differences in the intraoperative complications (bowel or vascular or organ injury), postoperative complications (cardiac, gastrointestinal, pulmonary), longer-than-expected hospital stay, and rate of blood transfusion. Increasing hospital volume was significantly associated with improved perioperative outcomes and lower costs. These differences were quite pronounced when comparing the lowest quartile to the highest quartile hospitals. As expected, the shorter stays and fewer complications were associated with lower total hospital costs at the high-volume centers.