High volume is the key for improving in-hospital outcomes after radical prostatectomy: a total population analysis in Germany from 2006 to 2013
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Outcomes of radical prostatectomy are prone to publication bias, because most of the data originated from highly specialized centers. We assessed in-hospital outcomes of all radical prostatectomies in Germany from 2006 to 2013 focusing on caseload volume, surgical approach, and certification status.
We analyzed the nationwide German hospital billing data covering 221,331 radical prostatectomies from 2006 to 2013. Outcomes were in-hospital mortality, surgical revision, and transfusion rates and the length of stay. Multivariate models described the impact of these factors.
The yearly number of radical prostatectomies declined from 28,374 to 21,850. While shares of all other approaches decreased, shares for robot-assisted prostatectomy increased from 0.6 to 25.2%. Hospitals with ≥100 cases a year reported lower in-hospital mortality with 0.08 versus 0.17% for hospitals with <50 cases a year. On multivariate analysis, the odds for an individual death were doubled in hospitals with <50 cases a year. All other factors showed no significant impact on mortality. Concerning blood transfusion, the surgical approach was the strongest predictor with minimally invasive surgery (26% of the odds of conventional surgery) followed by caseload volume. Surgical revision was frequent in hospitals with lower rates of minimally invasive approaches (OR 1.6) and smaller caseloads (OR 1.4). Length of stay was reduced by 3 days for caseloads ≥200 a year, 2 days with minimally invasive approaches, and 1 day in certified prostate cancer centers. Lacking clinical information is a major limitation.
Annual caseload volume of hospitals is the most important factor for improved in-hospital outcomes.
KeywordsProstate cancer Prostatectomy Caseload Robotics Health services research
Retropubic radical prostatectomy
Laparoscopic radical prostatectomy
Robot-assisted radical prostatectomy
Packed red blood cells
International classification of diseases
Classification of Operations and Procedures
German Federal Statistical Office
Med-Drive Grant of the Medical Faculty Carl Gustav Carus, TU Dresden. (Grant-number: 60.356).
Research data centers of the federal and state statistical offices, DRG-statistics 2006 to 2013, own calculations. We thank Stefanie Uhrich for continuously supporting data retrieval.
Author contribution statement
CG was involved in the project development, data collection, analysis and interpretation, manuscript writing, revision and final approval of the manuscript, obtaining funding, RK was involved in statistics, data collection, revision and final approval of the manuscript, MB was involved in graphics, statistical analysis, revision and final approval of the manuscript, MPW was involved in the project development, revising the manuscript for critically important intellectual content, revision and final approval of the manuscript, supervision, and JH was involved in the conception and design of the manuscript, revising it for critically important intellectual content, revision and final approval of the manuscript, obtaining funding.
Compliance of ethical standards
Conflict of interest
There is no conflict of interest.
Human and animal participant
No research involving human participants or animals was performed.
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