Variations in Morbidity after Radical Prostatectomy
Colin B. Begg, Ph.D., Elyn R. Riedel, M.A., Peter B. Bach, M.D., M.A.P.P., Michael W. Kattan, Ph.D., Deborah Schrag, M.D., M.P.H., Joan L. Warren, Ph.D., and Peter T. Scardino, M.D.
Background Recent studies of surgery for cancer have demonstratedvariations in outcomes among hospitals and among surgeons. Wesought to examine variations in morbidity after radical prostatectomyfor prostate cancer.
Methods We used the Surveillance, Epidemiology, and End Results–Medicarelinked data base to evaluate health-related outcomes after radicalprostatectomy. The rates of postoperative complications, lateurinary complications (strictures or fistulas 31 to 365 daysafter the procedure), and long-term incontinence (more than1 year after the procedure) were inferred from the Medicareclaims records of 11,522 patients who underwent prostatectomybetween 1992 and 1996. These rates were analyzed in relationto hospital volume and surgeon volume (the number of proceduresperformed at individual hospitals and by individual surgeons,respectively).
Results Neither hospital volume nor surgeon volume was significantlyassociated with surgery-related death. Significant trends inthe relation between volume and outcome were observed with respectto postoperative complications and late urinary complications.Postoperative morbidity was lower in very-high-volume hospitalsthan in low-volume hospitals (27 percent vs. 32 percent, P=0.03)and was also lower when the prostatectomy was performed by very-high-volumesurgeons than when it was performed by low-volume surgeons (26percent vs. 32 percent, P<0.001). The rates of late urinarycomplications followed a similar pattern. Results for long-termpreservation of continence were less clear-cut. In a detailedanalysis of the 159 surgeons who had a high or very high volumeof procedures, wide surgeon-to-surgeon variations in these clinicaloutcomes were observed, and they were much greater than wouldbe predicted on the basis of chance or observed variations inthe case mix.
Conclusions In men undergoing prostatectomy, the rates of postoperativeand late urinary complications are significantly reduced ifthe procedure is performed in a high-volume hospital and bya surgeon who performs a high number of such procedures.
Source Information
From the Health Outcomes Research Group, Department of Epidemiology and Biostatistics (C.B.B., E.R.R., P.B.B., M.W.K., D.S.), and the Department of Urology (M.W.K., P.T.S.), Memorial Sloan-Kettering Cancer Center, New York; and the Applied Research Branch, National Cancer Institute, Bethesda, Md. (J.L.W.).
Address reprint requests to Dr. Begg at the Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 44, New York, NY 10021, or at beggc{at}mskcc.org.
Volume and Outcome
Barone J. E., Risucci D. A., Savino J. A., Nallamothu B. K., Saint S., Eagle K. A., Senkowski C. K., Kocs D. M., Rowe A. K., Deming M. S., Bohmer R., Edmondson A., Pisano G., Ghertner J. L., Babson W. W. Jr., Birkmeyer J. D., Finlayson E. V.A., Epstein A. M.
Extract |
Full Text |
PDF
N Engl J Med 2002;
347:693-696, Aug 29, 2002.
Correspondence
This article has been cited by other articles:
Putt, M., Long, J. A., Montagnet, C., Silber, J. H., Chang, V. W., Kaijun Liao, , Schwartz, J. S., Pollack, C. E., Wong, Y.-N., Armstrong, K.
(2009). Racial Differences in the Impact of Comorbidities on Survival Among Elderly Men With Prostate Cancer. Med Care Res Rev
66: 409-435
[Abstract]
Ehlenbach, W. J., Barnato, A. E., Curtis, J. R., Kreuter, W., Koepsell, T. D., Deyo, R. A., Stapleton, R. D.
(2009). Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly. NEJM
361: 22-31
[Abstract][Full Text]
Brawley, O. W., Ankerst, D. P., Thompson, I. M.
(2009). Screening for Prostate Cancer. CA Cancer J Clin
59: 264-273
[Abstract][Full Text]
Sanda, M. G., Kaplan, I. D.
(2009). A 64-Year-Old Man With Low-Risk Prostate Cancer: Review of Prostate Cancer Treatment. JAMA
301: 2141-2151
[Abstract][Full Text]
Dixon, H., Scully, M., Wakefield, M., Murphy, M.
(2009). The prostate cancer screening debate: public reaction to medical controversy in the media. Public Understanding of Science
18: 115-128
[Abstract]
Barry, M. J.
(2008). Screening for Prostate Cancer among Men 75 Years of Age or Older. NEJM
359: 2515-2516
[Full Text]
Paulson, E. C., Ra, J., Armstrong, K., Wirtalla, C., Spitz, F., Kelz, R. R.
(2008). Underuse of Esophagectomy as Treatment for Resectable Esophageal Cancer. Arch Surg
143: 1198-1203
[Abstract][Full Text]
Tewari, A. K., Jhaveri, J. K., Surasi, K., Patel, N., Tan, G. Y.
(2008). Benefit of Robotic Assistance in Comparing Outcomes of Minimally Invasive Versus Open Radical Prostatectomy. JCO
26: 4999-5000
[Full Text]
Hu, J. C.
(2008). In Reply. JCO
26: 5001-5002
[Full Text]
Elkin, E. B., Ishill, N., Riley, G. F., Bach, P. B., Gonen, M., Begg, C. B., Schrag, D.
(2008). Disenrollment From Medicare Managed Care Among Beneficiaries With and Without a Cancer Diagnosis. JNCI J Natl Cancer Inst
100: 1013-1021
[Abstract][Full Text]
Macrae, W. A.
(2008). Chronic post-surgical pain: 10 years on. Br J Anaesth
101: 77-86
[Abstract][Full Text]
Ra, J., Paulson, E. C., Kucharczuk, J., Armstrong, K., Wirtalla, C., Rapaport-Kelz, R., Kaiser, L. R., Spitz, F. R.
(2008). Postoperative Mortality After Esophagectomy for Cancer: Development of a Preoperative Risk Prediction Model. Ann. Surg. Oncol.
15: 1577-1584
[Abstract][Full Text]
Hu, J. C., Wang, Q., Pashos, C. L., Lipsitz, S. R., Keating, N. L.
(2008). Utilization and Outcomes of Minimally Invasive Radical Prostatectomy. JCO
26: 2278-2284
[Abstract][Full Text]
Williams, S. C., Koss, R. G., Morton, D. J., Schmaltz, S. P., Loeb, J. M.
(2008). Case volume and hospital compliance with evidence-based processes of care. Int J Qual Health Care
20: 79-87
[Abstract][Full Text]
Hershman, D. L., Buono, D., McBride, R. B., Tsai, W. Y., Joseph, K. A., Grann, V. R., Jacobson, J. S.
(2008). Surgeon Characteristics and Receipt of Adjuvant Radiotherapy in Women With Breast Cancer. JNCI J Natl Cancer Inst
100: 199-206
[Abstract][Full Text]
Carrier, M. MD, Wells, P. S. MD MSc
(2008). Should we regionalize the management of pulmonary embolism?. CMAJ
178: 58-60
[Full Text]
Markman, M.
(2007). Concept of Optimal Surgical Cytoreduction in Advanced Ovarian Cancer: A Brief Critique and a Call for Action. JCO
25: 4168-4170
[Full Text]
Hollenbeck, B. K., Hong Ji, , Zaojun Ye, , Birkmeyer, J. D.
(2007). Misclassification of Hospital Volume With Surveillance, Epidemiology, and End Results Medicare Data. SURG INNOV
14: 192-198
[Abstract]
Vickers, A. J., Bianco, F. J., Serio, A. M., Eastham, J. A., Schrag, D., Klein, E. A., Reuther, A. M., Kattan, M. W., Pontes, J. E., Scardino, P. T.
(2007). The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy. JNCI J Natl Cancer Inst
99: 1171-1177
[Abstract][Full Text]
Hricak, H., Choyke, P. L., Eberhardt, S. C., Leibel, S. A., Scardino, P. T.
(2007). Imaging Prostate Cancer: A Multidisciplinary Perspective. Radiology
243: 28-53
[Abstract][Full Text]
Porter, M. E., Teisberg, E. O.
(2007). How Physicians Can Change the Future of Health Care. JAMA
297: 1103-1111
[Abstract][Full Text]
Gilligan, M. A., Neuner, J., Zhang, X., Sparapani, R., Laud, P. W., Nattinger, A. B.
(2007). Relationship Between Number of Breast Cancer Operations Performed and 5-Year Survival After Treatment for Early-Stage Breast Cancer. Am. J. Public Health
97: 539-544
[Abstract][Full Text]
Zhang, W., Ayanian, J. Z., Zaslavsky, A. M.
(2007). Patient characteristics and hospital quality for colorectal cancer surgery. Int J Qual Health Care
19: 11-20
[Abstract][Full Text]
Katz, S. J., Hofer, T. P., Hawley, S., Lantz, P. M., Janz, N. K., Schwartz, K., Liu, L., Deapen, D., Morrow, M.
(2007). Patterns and Correlates of Patient Referral to Surgeons for Treatment of Breast Cancer. JCO
25: 271-276
[Abstract][Full Text]
Gilligan, M. A., Neuner, J., Sparapani, R., Laud, P. W., Nattinger, A. B.
(2007). Surgeon Characteristics and Variations in Treatment for Early-Stage Breast Cancer. Arch Surg
142: 17-22
[Abstract][Full Text]
Billingsley, K. G., Morris, A. M., Dominitz, J. A., Matthews, B., Dobie, S., Barlow, W., Wright, G. E., Baldwin, L.-M.
(2007). Surgeon and Hospital Characteristics as Predictors of Major Adverse Outcomes Following Colon Cancer Surgery: Understanding the Volume-Outcome Relationship. Arch Surg
142: 23-31
[Abstract][Full Text]
Otto, S. J., Schroder, F. H., de Koning, H. J.
(2006). Risk of Cardiovascular Mortality in Prostate Cancer Patients in the Rotterdam Randomized Screening Trial. JCO
24: 4184-4189
[Abstract][Full Text]
Alibhai, S. M. H., Leach, M., Tomlinson, G., Krahn, M. D., Fleshner, N., Holowaty, E., Naglie, G.
(2005). 30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity. JNCI J Natl Cancer Inst
97: 1525-1532
[Abstract][Full Text]
Al-Khatib, S. M., Lucas, F. L., Jollis, J. G., Malenka, D. J., Wennberg, D. E.
(2005). The Relation Between Patients' Outcomes and the Volume of Cardioverter-Defibrillator Implantation Procedures Performed by Physicians Treating Medicare Beneficiaries. J Am Coll Cardiol
46: 1536-1540
[Abstract][Full Text]
Edwards, B. K., Brown, M. L., Wingo, P. A., Howe, H. L., Ward, E., Ries, L. A. G., Schrag, D., Jamison, P. M., Jemal, A., Wu, X. C., Friedman, C., Harlan, L., Warren, J., Anderson, R. N., Pickle, L. W.
(2005). Annual Report to the Nation on the Status of Cancer, 1975-2002, Featuring Population-Based Trends in Cancer Treatment. JNCI J Natl Cancer Inst
97: 1407-1427
[Abstract][Full Text]
Gammon, S. R., Berni, K. C., Virgo, K. S., Johnson, F. E.
(2005). Surgical Treatment for Prostate Cancer in Patients With Prior Spinal Cord Injury. Ann. Surg. Oncol.
12: 674-678
[Abstract][Full Text]
Miller, D. C., Sanda, M. G., Dunn, R. L., Montie, J. E., Pimentel, H., Sandler, H. M., McLaughlin, W. P., Wei, J. T.
(2005). Long-Term Outcomes Among Localized Prostate Cancer Survivors: Health-Related Quality-of-Life Changes After Radical Prostatectomy, External Radiation, and Brachytherapy. JCO
23: 2772-2780
[Abstract][Full Text]
Committee on Fetus and Newborn,
(2004). Levels of Neonatal Care. Pediatrics
114: 1341-1347
[Abstract][Full Text]
Birkmeyer, J. D.
(2004). Understanding Surgeon Performance and Improving Patient Outcomes. JCO
22: 2765-2766
[Full Text]
Lange, P. H., Lin, D. W.
(2004). Does the Who and How of Surgery in Bladder Cancer Matter?. JCO
22: 2762-2764
[Full Text]
Mullerad, M., Hricak, H., Wang, L., Chen, H.-N., Kattan, M. W., Scardino, P. T.
(2004). Prostate Cancer: Detection of Extracapsular Extension by Genitourinary and General Body Radiologists at MR Imaging. Radiology
232: 140-146
[Abstract][Full Text]
Birkmeyer, J. D., Stukel, T. A., Siewers, A. E., Goodney, P. P., Wennberg, D. E., Lucas, F. L.
(2003). Surgeon Volume and Operative Mortality in the United States. NEJM
349: 2117-2127
[Abstract][Full Text]
Panageas, K. S., Schrag, D., Riedel, E., Bach, P. B., Begg, C. B.
(2003). The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes. ANN INTERN MED
139: 658-665
[Abstract][Full Text]
Harisinghani, M. G., Barentsz, J., Hahn, P. F., Deserno, W. M., Tabatabaei, S., van de Kaa, C. H., de la Rosette, J., Weissleder, R.
(2003). Noninvasive Detection of Clinically Occult Lymph-Node Metastases in Prostate Cancer. NEJM
348: 2491-2499
[Abstract][Full Text]
Talcott, J. A.
(2003). Quality of Care in Prostate Cancer: Important to Start and Too Important to Stop Here. JCO
21: 1902-1903
[Full Text]
Spencer, B. A., Steinberg, M., Malin, J., Adams, J., Litwin, M. S.
(2003). Quality-of-Care Indicators for Early-Stage Prostate Cancer. JCO
21: 1928-1936
[Abstract][Full Text]
Carter, D.
(2003). The surgeon as a risk factor. BMJ
326: 832-833
[Full Text]
Hoffman, R. M.
(2003). An Argument Against Routine Prostate Cancer Screening. Arch Intern Med
163: 663-665
[Full Text]
Shahian, D. M., Normand, S.-L. T.
(2003). The volume-outcome relationship: from Luft to Leapfrog. Ann. Thorac. Surg.
75: 1048-1058
[Abstract][Full Text]
Bennett, C. L., Somerfield, M. R., Pfister, D. G., Tomori, C., Yakren, S., Bach, P. B.
(2003). Perspectives on the Value of American Society of Clinical Oncology Clinical Guidelines as Reported by Oncologists and Health Maintenance Organizations. JCO
21: 937-941
[Abstract][Full Text]
Beam, C. A., Conant, E. F., Sickles, E. A.
(2003). Association of Volume and Volume-Independent Factors With Accuracy in Screening Mammogram Interpretation. JNCI J Natl Cancer Inst
95: 282-290
[Abstract][Full Text]
Begg, C. B., Scardino, P. T.
(2003). Taking Stock of Volume-Outcome Studies. JCO
21: 393-394
[Full Text]
Hu, J. C., Gold, K. F., Pashos, C. L., Mehta, S. S., Litwin, M. S.
(2003). Role of Surgeon Volume in Radical Prostatectomy Outcomes. JCO
21: 401-405
[Abstract][Full Text]
Katz, M. S., Zelefsky, M. J., Venkatraman, E. S., Fuks, Z., Hummer, A., Leibel, S. A.
(2003). Predictors of Biochemical Outcome With Salvage Conformal Radiotherapy After Radical Prostatectomy for Prostate Cancer. JCO
21: 483-489
[Abstract][Full Text]
Blendon, R. J., DesRoches, C. M., Brodie, M., Benson, J. M., Rosen, A. B., Schneider, E., Altman, D. E., Zapert, K., Herrmann, M. J., Steffenson, A. E.
(2002). Views of Practicing Physicians and the Public on Medical Errors. NEJM
347: 1933-1940
[Abstract][Full Text]
Harris, R., Lohr, K. N.
(2002). Screening for Prostate Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force. ANN INTERN MED
137: 917-929
[Abstract][Full Text]
Soljak, M.
(2002). Volume of procedures and outcome of treatment. BMJ
325: 787-788
[Full Text]
Walsh, P. C.
(2002). Surgery and the Reduction of Mortality from Prostate Cancer. NEJM
347: 839-840
[Full Text]
Barone, J. E., Risucci, D. A., Savino, J. A., Nallamothu, B. K., Saint, S., Eagle, K. A., Senkowski, C. K., Kocs, D. M., Rowe, A. K., Deming, M. S., Bohmer, R., Edmondson, A., Pisano, G., Ghertner, J. L., Babson, W. W. Jr., Birkmeyer, J. D., Finlayson, E. V.A., Epstein, A. M.
(2002). Volume and Outcome. NEJM
347: 693-696
[Full Text]
Begg, C. B., Schrag, D.
(2002). Attribution of Deaths Following Cancer Treatment. JNCI J Natl Cancer Inst
94: 1044-1045
[Full Text]
Epstein, A. M.
(2002). Volume and Outcome -- It Is Time to Move Ahead. NEJM
346: 1161-1164
[Full Text]
Previous
