Quoc-Dien Trinh1, Maxine Sun2, Simon P Kim3, Jesse Sammon4, Keith J Kowalczyk5, Ariella A Friedman4, Shyam Sukumar4, Praful Ravi4, Fred Muhletaler4, Piyush K Agarwal6, Shahrokh F Shariat7, Jim C Hu8, Mani Menon4, Pierre I Karakiewicz2. 1. Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: trinh.qd@gmail.com. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. 3. Department of Urology, Mayo Clinic, Rochester, MN, USA. 4. Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. 5. Department of Urology, Georgetown University Hospital, Washington, DC. 6. Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA. 7. Department of Urology, Weill Medical College of Cornell University, New York, NY. 8. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
Abstract
OBJECTIVES: Although high-volume hospitals have been associated with improved outcomes for radical prostatectomy (RP), the association of residency or fellowship teaching institutions or both and this volume-outcome relationship remains poorly described. We examine the effect of teaching status and hospital volume on perioperative RP outcomes. METHODS AND MATERIALS: Within the Nationwide Inpatient Sample, we focused on RPs performed between 2003 and 2007. We tested the rates of prolonged length of stay beyond the median of 3 days, in-hospital mortality, and intraoperative and postoperative complications, stratified according to teaching status. Multivariable logistic regression analyses further adjusted for confounding factors. RESULTS: Overall, 47,100 eligible RPs were identified. Of these, 19,193 cases were performed at non-teaching institutions, 24,006 at residency teaching institutions, and 3,901 at fellowship teaching institutions. Relative to patients treated at non-teaching institutions, patients treated at fellowship teaching institutions were healthier and more likely to hold private insurance. In multivariable analyses, patients treated at residency (OR = 0.92, P = 0.015) and fellowship (OR = 0.82, P = 0.011) teaching institutions were less likely to experience a postoperative complication than patients treated at non-teaching institutions. Patients treated at residency (OR = 0.73, P<0.001) and fellowship (OR = 0.91, P = 0.045) teaching institutions were less likely to experience a prolonged length of stay. CONCLUSIONS: More favorable postoperative complication profile and shorter length of stay should be expected at residency and fellowship teaching institutions following RP. Moreover, postoperative complication rates were lower at fellowship teaching than at residency teaching institutions, despite adjustment for potential confounders.
OBJECTIVES: Although high-volume hospitals have been associated with improved outcomes for radical prostatectomy (RP), the association of residency or fellowship teaching institutions or both and this volume-outcome relationship remains poorly described. We examine the effect of teaching status and hospital volume on perioperative RP outcomes. METHODS AND MATERIALS: Within the Nationwide Inpatient Sample, we focused on RPs performed between 2003 and 2007. We tested the rates of prolonged length of stay beyond the median of 3 days, in-hospital mortality, and intraoperative and postoperative complications, stratified according to teaching status. Multivariable logistic regression analyses further adjusted for confounding factors. RESULTS: Overall, 47,100 eligible RPs were identified. Of these, 19,193 cases were performed at non-teaching institutions, 24,006 at residency teaching institutions, and 3,901 at fellowship teaching institutions. Relative to patients treated at non-teaching institutions, patients treated at fellowship teaching institutions were healthier and more likely to hold private insurance. In multivariable analyses, patients treated at residency (OR = 0.92, P = 0.015) and fellowship (OR = 0.82, P = 0.011) teaching institutions were less likely to experience a postoperative complication than patients treated at non-teaching institutions. Patients treated at residency (OR = 0.73, P<0.001) and fellowship (OR = 0.91, P = 0.045) teaching institutions were less likely to experience a prolonged length of stay. CONCLUSIONS: More favorable postoperative complication profile and shorter length of stay should be expected at residency and fellowship teaching institutions following RP. Moreover, postoperative complication rates were lower at fellowship teaching than at residency teaching institutions, despite adjustment for potential confounders.
Authors: Brent K Hollenbeck; Rodney L Dunn; David C Miller; Stephanie Daignault; David A Taub; John T Wei Journal: J Clin Oncol Date: 2007-01-01 Impact factor: 44.544
Authors: Lars Budäus; Firas Abdollah; Maxine Sun; Monica Morgan; Rupinder Johal; Rodolphe Thuret; Kevin C Zorn; Hendrik Isbarn; Shahrokh F Shariat; Francesco Montorsi; Paul Perrotte; Markus Graefen; Pierre I Karakiewicz Journal: J Urol Date: 2010-10-16 Impact factor: 7.450
Authors: Felix Preisser; Sebastiano Nazzani; Elio Mazzone; Sophie Knipper; Marco Bandini; Zhe Tian; Alexander Haese; Fred Saad; Kevin C Zorn; Francesco Montorsi; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Pierre I Karakiewicz Journal: World J Urol Date: 2018-10-12 Impact factor: 4.226
Authors: Akshay Sood; Firas Abdollah; Jesse D Sammon; Kaustav Majumder; Marianne Schmid; James O Peabody; Mark A Preston; Adam S Kibel; Mani Menon; Quoc-Dien Trinh Journal: World J Surg Date: 2015-10 Impact factor: 3.352
Authors: Akshay Sood; Firas Abdollah; Jesse D Sammon; Victor Kapoor; Craig G Rogers; Wooju Jeong; Dane E Klett; Julian Hanske; Christian P Meyer; James O Peabody; Mani Menon; Quoc-Dien Trinh Journal: World J Urol Date: 2015-04-25 Impact factor: 4.226
Authors: Ashraf Almatar; Christopher J D Wallis; Sender Herschorn; Refik Saskin; Girish S Kulkarni; Ronald T Kodama; Robert K Nam Journal: Can Urol Assoc J Date: 2016 Jan-Feb Impact factor: 1.862
Authors: Florian Roghmann; Praful Ravi; Julian Hanske; Christian P Meyer; Mark A Preston; Joachim Noldus; Quoc-Dien Trinh Journal: Can Urol Assoc J Date: 2015 May-Jun Impact factor: 1.862