Table C37Association between surgeon volumes (radical prostatectomy) and complications (cardiac, respiratory or vascular events, the need for reoperation, bleeding, renal failure, and shock)

Reference Period DesignPopulationData Source Volume DefinitionOutcomeAnalysis UnitsRisk AdjustmentVolume CategoriesCrude Rate (%)Adjusted Volume Effect
Begg, 2002122 11,522 Medicare beneficiaries (Parts A and B) after radical prostatectomySEER data base linked to Medicare claimsPostoperative complications during 30 days after surgeryGEE logistic regressionPatient age, race, stage of cancer, comorbidities Annual surgeon volume (% surgeons) Postoperative complications
1992-19966,421 with localized PC403 hospitalsUnit: PatientHospital - surgeon correlations1–4 (64) 32
Retrospective cohort999 surgeonsAverage number of procedures/yearGoodness-of-fit: Not reported5–9 (20) 31
Evidence: II-2CDiscrimination: Not reported10–15 (10) 30
Quality: 0.6316–58 (6) 26
Hu, 2002118 2,292 Medicare beneficiaries after radical prostatectomyMedicare claims dataPostoperative in hospital complicationsMultiple regressionPatient age, race, comorbidities, hospital type, region Surgeon volume (% of procedures) Postoperative complications
1997-1998Number of procedures/time of the studyUnit: PatientLow (92.2)21.91 (reference)
Retrospective cohortGoodness-of-fit: Not reported(<40/year)
Evidence: II-2CDiscrimination: YesHigh (7.8)11.80.53 (0.32; 0.89)
Quality: 0.86(>40/year)
Subgroups by hospital/surgeon volume
Low-low22.4
High-low18.6
Low-high13.6
High-high10.5
Bianco, 1999131 5,238 Medicare beneficiaries (Parts A and B) after radical prostatectomySEER data base linked to Medicare claimsPostoperative in-hospital complicationsLogistic regressionPatient age, cancer stage, comorbidities, hospital volumeSurgeon volumePostoperative complications
1993-1996159 surgeonsNumber of procedures/time of the studyVariability in outcome among high volume surgeonsUnit Patient20–121
Retrospective cohortGoodness-of-fit: Not reportedAnnual average volume = 1728.6
Evidence: II-2CDiscrimination: Not reported4 surgeons<15
Quality:0.6312 surgeons>50
Annual average volume = 17Late urinary complication 25.2
Annual average volume = 17Long term urinary complications 6.7
Dash, 2004132 1,123 patients after radical retropubic prostatectomyConsecutive cases prospectively enrolled in the IRB approved studySurgery related blood transfusionLogistic regressionPatient age, race, hormone therapy use, clinical stage and grade, and prostate size; type of anesthesiaAnnual surgeon Volume (% of patients)Homologous transfusion rate
1994-2000Single academic center; 9 surgeonsAverage number of procedures/yearUnit Patient>15/year (94)31
Prospective cohortGoodness-of-fit: Not reported<15/year (6)18.28.63 (3.95; 18.86)
Evidence: II-2BDiscrimination: Not reported(range 0–20.6)
Quality: 0.69
Litwiller, 1995133 428 patients after radical retropubic prostatectomyRecords of all patients admitted to the hospital from 1984-1994; number of procedures performed by surgeon / study periodSurgery related blood loss and transfusionLinear regressionPatient age, stage of cancer, comorbiditiesAverage surgeon volumeAverage blood loss 1,327 ml
1984-1994Single academic center; 18 surgeonsGoodness-of-fit: Not reported3 procedures (rank 1–9)
Design: Retrospective analysis of casesDiscrimination: Not reportedCorrelation with blood loss-0.31 (Not significant)
Evidence: IIICorrelation with transfusionAverage blood transfusions 1.57U
Quality: 0.47-0.37 (Not significant)

From: Appendix C, Evidence Tables and Figures

Cover of Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer
Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer [Internet].
Comparative Effectiveness Reviews, No. 13.
Wilt TJ, Shamliyan T, Taylor B, et al.

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