Variations in morbidity after radical prostatectomy Journal Article


Authors: Begg, C. B.; Riedel, E. R.; Bach, P. B.; Kattan, M. W.; Schrag, D.; Warren, J. L.; Scardino, P. T.
Article Title: Variations in morbidity after radical prostatectomy
Abstract: Background: Recent studies of surgery for cancer have demonstrated variations in outcomes among hospitals and among surgeons. We sought to examine variations in morbidity after radical prostatectomy for prostate cancer. Methods: We used the Surveillance, Epidemiology, and End Results-Medicare linked data base to evaluate health-related outcomes after radical prostatectomy. The rates of postoperative complications, late urinary complications (strictures or fistulas 31 to 365 days after the procedure), and long-term incontinence (more than 1 year after the procedure) were inferred from the Medicare claims records of 11,522 patients who underwent prostatectomy between 1992 and 1996. These rates were analyzed in relation to hospital volume and surgeon volume (the number of procedures performed at individual hospitals and by individual surgeons, respectively). Results: Neither hospital volume nor surgeon volume was significantly associated with surgery-related death. Significant trends in the relation between volume and outcome were observed with respect to postoperative complications and late urinary complications. Postoperative morbidity was lower in very-high-volume hospitals than in low-volume hospitals (27 percent vs. 32 percent, P=0.03) and was also lower when the prostatectomy was performed by very-high-volume surgeons than when it was performed by low-volume surgeons (26 percent vs. 32 percent, P<0.001). The rates of late urinary complications followed a similar pattern. Results for long-term preservation of continence were less clear-cut. In a detailed analysis of the 159 surgeons who had a high or very high volume of procedures, wide surgeon-to-surgeon variations in these clinical outcomes were observed, and they were much greater than would be predicted on the basis of chance or observed variations in the case mix. Conclusions: In men undergoing prostatectomy, the rates of postoperative and late urinary complications are significantly reduced if the procedure is performed in a high-volume hospital and by a surgeon who performs a high number of such procedures. Copyright © 2002 Massachusetts Medical Society.
Keywords: adult; controlled study; treatment outcome; aged; surgical technique; major clinical study; fistula; treatment planning; united states; clinical practice; morbidity; outcome assessment (health care); postoperative complication; postoperative complications; prostatic neoplasms; hospitals; medicare; urine incontinence; prostatectomy; ureter stricture; surgery; seer program; hospital admission; urinary incontinence; prostate carcinoma; urethra stricture; urologic diseases; urinary dysfunction; humans; human; male; priority journal; article
Journal Title: New England Journal of Medicine
Volume: 346
Issue: 15
ISSN: 0028-4793
Publisher: Massachusetts Medical Society  
Date Published: 2002-04-11
Start Page: 1138
End Page: 1144
Language: English
DOI: 10.1056/NEJMsa011788
PUBMED: 11948274
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Colin B Begg
    285 Begg
  2. Peter T Scardino
    656 Scardino
  3. Deborah Schrag
    143 Schrag
  4. Peter Bach
    250 Bach
  5. Michael W Kattan
    218 Kattan