Radical retropubic prostatectomy for localized carcinoma of the prostate in a large metropolitan hospital: changing trends over a 10-year period (1984-1994). Dallas Outcomes Research Group for Urological Disorders.

OBJECTIVES: To analyze changing trends in the surgical treatment for localized carcinoma of the prostate in a large metropolitan community hospital over a 10-year period from 1984 to 1994.
METHODS: The records of all 428 patients who underwent radical prostatectomy for localized carcinoma of the prostate from January 1, 1984, to January 1, 1994, at a large metropolitan community hospital (Baylor University Medical Center, Dallas, Tex) were retrieved and data abstracted in a predefined computerized database by a urology resident who was not part of the patient's surgical team. The abstracted data included attending surgeon, date of surgery, patient's age, clinical stage at presentation and pathologic stage, prostate-specific antigen (PSA), perioperative events, such as duration of surgery, blood loss, transfusion, duration of hospital stay, comorbidities according to the Charlson comorbidity index, and others. The data were analyzed in regard to changes over the 10-year period and stratified by a variety of parameters.
RESULTS: The number of radical prostatectomies performed increased by fourfold from 1984 to 1993. The distribution of clinical stage and the incidence of pathologic upstaging noted in the 428 cases were similar to other series reported in the literature. The average age of patients decreased from 67 to 63 years over the 10 years (average calculated in increments of 15 cases in ascending order). Similarly, over time the average duration of surgery, average blood loss, average use of transfusion, and the average duration of hospital stay decreased. When the cases were grouped by individual attending surgeon, whose numerical surgical experience during that time period ranged from 1 to 76 cases, no correlation was noted between the numerical experience and these outcomes.
CONCLUSIONS: As opposed to the national Medicare experience recently reported by the Prostate Patients Outcome Research Team, the increase in the number of cases performed was mostly due to patients under the age of 70 years, considered reasonable candidates for radical prostatectomy. Independent of numerical experience of individual attending surgeons, duration of surgery, blood loss, transfusion rates, and duration of hospital stay decreased during this period. This might indicate a learning effect due to continuing education, exchange of ideas, published technical improvements in the surgical procedure, and other factors, ultimately benefiting the patient by improving outcomes.