Is there a volume–outcome relationship for partial nephrectomy?

Abstract

PN is more frequently performed in high volume institutions particularly for small renal masses. We observed increase positive margin and complication rates in moderate volume centers that might be explained by an increased use of laparoscopy.

Hospital volume and outcomes of robot‐assisted partial nephrectomy

“…Hospital volume categories were determined according to the following criteria: very low volume, 1-7 cases (n = 3 693); low volume, 8-14 cases (n = 3 719); medium volume, 15-23 cases (n = 3 833); high volume, 24-43 cases (n = 3 649); and very high volume, ≥44 cases (3 830). The median (interquartile range) hospital volume increased from 15 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Baseline characteristics of the cohort are summarized in Table 1. The unadjusted outcome comparison across the strata of hospital volume is shown in Fig.…”

“…Sun et al analysed a PN sub‐cohort from the 1998–2007 Nationwide Inpatient Sample (NIS) and found that hospitals with higher nephrectomy (PN + RN) volume had shorter LOS and lower rates of blood transfusion. A French multicentre study showed that higher hospital PN volume was associated with better peri‐operative outcomes, including favourable LOS, warm ischaemia time, medical complications and haemoglobin decrease . One limitation of both studies was the compilation of PN approaches (open, laparoscopic and robot‐assisted), with most patients in their cohorts undergoing open surgery.…”

The Impact of Hospital Volume on Postoperative Complications Following Robot-Assisted Partial Nephrectomy

“…4,5 Adoption of RA for PN and other urologic procedures has been exponential in the past decade in both academic and community institutions without significant oversight or credentialing of operative competence. Given this rapid increase in utilization of robotic assistance and the fact that previous studies have demonstrated an inverse relationship between hospital volume and postoperative complications following nephrectomy, [6][7][8][9] we sought to evaluate if this relationship existed for RAPN. We hypothesized that a difference would be identified because RAPN is a complex reconstructive procedure with a significant learning curve.…”

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

“…[8][9][10] In the absence of randomized trials providing strong clinical evidence, several factors have been advocated as predictors of PSMs after NSS, such as tumor size, 11 pathological stage, 9 Fuhrman grade, 12 indication for NSS (elective vs. imperative), 11 and surgical volume. 13 Conversely, the surgical approach (open vs. minimally invasive), and surgical technique (standard PN vs. SE), appear to be unrelated to margins status, according to the largest currently available evidence.…”