A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer

Broeck, Thomas Van den; Oprea-Lager, Daniela E.; Moris, Lisa; Kailavasan, Mithun; Briers, Erik; Cornford, Philip; Santis, Maria De; Gandaglia, Giorgio; Sommer, S.; Grummet, Jeremy; Grivas, Nikos; Lam, Thomas; Lardas, Michael; Liew, Matthew; Mason, Malcolm David; O’Hanlon, Shane; Pečánka, Jakub; Ploussard, Guillaume; Rouvière, Olivier; Schoots, Ivo G.; Tilki, Derya; Bergh, Roderick C.N. van den; Poel, Henk van der; Wiegel, Thomas; Willemse, Peter‐Paul M.; Yuan, Yuhong; Mottet, Nicolas

doi:10.1016/j.eururo.2021.04.028

Cited by 26 publications

(14 citation statements)

References 79 publications

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“…In the present study, no correlation was noted between the SDD rate per center and the risk of readmission. These findings may be partly explained by the association between SDD and high-volume centers, reinforcing the role of RARP caseload in improving outcomes [9] . Another point is that the acceptance of SDD may be gradual as surgeons become more and more comfortable with a higher caseload and RARP experience.…”

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confidence: 71%

Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis

Ploussard

Grabia

Barret

et al. 2022

European Urology Open Science

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There are no countrywide data regarding the utilization of same-day-discharge (SDD) surgery for robot-assisted radical prostatectomy (RARP). We aimed to evaluate the annual number of SDD RARP procedures in France and to compare postoperative outcomes in SDD versus non-SDD centers. Data for all 9651 patients undergoing RARP in France in 2020 were extracted from the central database of the national healthcare system. Endpoints were length of hospital stay, patient age, center volume, lymph node dissection, and the hospital readmission rate. Overall, 184 SDD cases (1.9%) were reported in 14.2% of RARP centers. The annual RARP and SDD RARP caseload ranged from 41 to 485, and from one to 47, respectively, in SDD centers. SDD was significantly associated with higher-volume centers ( p < 0.001). No difference in readmission rate (7.9% vs 5.1%; p = 0.141) was observed for SDD versus non-SDD centers. Direct stay costs were estimated at €1457 in SDD centers compared to €2021 in non-SDD centers. The main limitation is the lack of detailed patient characteristics and readmission causes. This annual nationwide analysis suggests that SDD RARP remains infrequently used in routine practice in France despite being associated with comparable short-term outcomes after RARP and potential cost benefits. Patient summary We evaluated the use of robot-assisted removal of the prostate (RARP) with same-day hospital discharge in France for men with prostate cancer. In 2020, only 1.9% of the 9651 RARP procedures involved same-day discharge, even though the data show that this approach has lower costs and comparable safety.

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confidence: 71%

Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis

Ploussard

Grabia

Barret

et al. 2022

European Urology Open Science

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“…However, it appears logical especially without a structured mentoring program that already learned skills will diminish when time is too long in between two cases. Similarly, the institutional caseload seems important in this regard, as beside personal frequency of interventions, a high level of competence of the team in dealing with the intervention ensures high quality surgical outcomes [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Learning curve and functional outcomes after laser enucleation of the prostate for benign prostate hyperplasia according to surgeon’s caseload

et al. 2022

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Purpose To evaluate the impact of surgical caseload on safety, efficacy, and functional outcomes of laser enucleation of the prostate (LEP) applying a structured mentoring program. Methods Patient characteristics, perioperative data, and functional outcomes were analyzed descriptively. Linear and logistic regression models analyzed the effect of caseload on complications, functional outcomes and operative speed. Within the structured mentoring program a senior surgeon was present for the first 24 procedures completely, for partial steps in procedures 25–49, and as needed thereafter. Results A total of 677 patients from our prospective institutional database (2017–2022) were included for analysis. Of these, 84 (12%), 75 (11%), 82 (12%), 106 (16%), and 330 patients (49%) were operated by surgeons at (A) < 25, (B) 25–49, (C) 50–99, (D) 100–199, and (E) ≥ 200 procedures. Preoperative characteristics were balanced (all p > 0.05) except for prostate volume, which increased with caseload. There was no significant difference in change of IPSS, Quality of life, ICIQ, pad usage, peak urine flow, residual urine, and major complications (Group A: 8.3 to E: 7.6%, p = 0.2) depending on the caseload. Caseload was not associated (Odds ratio: 0.7–1.4, p > 0.2) with major complications in the multivariable logistic regression model. Only operating time was significantly shorter with increasing caseload in the multivariable analysis (111–55 min, beta 23.9–62.9, p < 0.001). Conclusion With a structured mentoring program, the safety and efficacy of LEP can be ensured even during the learning curve with very good outcome quality. Only the operating time decreases significantly with increasing experience of the surgeon.

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“…A study by Barashi et al [35] showed a significantly lower risk of RIs during prostatectomy for high-volume (>43 cases per year) versus low-volume (one to 43 cases per year) institutions (odds ratio [OR]: 0.58; 95% CI 0.46–0.72). More recently, Van den Broeck et al [36] stated that a caseload of >86 procedures per year is associated with a lower complication rate. Similarly, Schmitges et al [37] found that the volume of each surgeon affects RI as well: lower-volume surgeons (seven or fewer cases per year) have an OR for an RI of 3.26 (95% CI 1.93–5.51) compared with very-high-volume surgeons (51 cases per year).…”

Section: Complication Eventmentioning

confidence: 99%

Rectal Perforation During Pelvic Surgery

Rocco¹,

Giorgia²,

Simone³

et al. 2022

European Urology Open Science

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A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer

Cited by 26 publications

References 79 publications

Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis

Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis

Learning curve and functional outcomes after laser enucleation of the prostate for benign prostate hyperplasia according to surgeon’s caseload

Rectal Perforation During Pelvic Surgery

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