Table C31Association between hospital volumes (radical prostatectomy) and surgery related mortality

Reference Period DesignPopulationData Source Volume DefinitionOutcomeAnalysis/UnitsRisk AdjustmentVolume CategoriesOutcome Rate (%)Adjusted Volume Effect
Ellison, 2000 121 66,693 patients after prostatectomy; 1,334 hospitalsNationwide Inpatient Sample databaseIn-hospital death after radical prostatectomyMultiple logistic regressionPatient age and comorbidity Annual Hospital Volume (% hospitals) Odds ratio
1989-1996Average number of procedures/yearUnit: patient<25 (76)0.31.78 (1.2; 2.7)
Retrospective cohortGoodness-of-fit: Yes25–54 (17)0.281.71 (1.2; 2.6)
Evidence: II-2CDiscrimination: Not reported>54 (7)0.171 (reference)
Quality: 0.75 Subgroups by patient age
>65 years
Volume
<250.4
25–540.38
>540.25
<65 years
Volume
<250.15
25–540.15
>540.5
Begg,2002 122 11,522 Medicare beneficiaries (Parts A and B) after radical prostatectomySEER data base linked to Medicare claims.Postoperative death within 30–60 days after radical prostatectomyGEE-logistic regressionPatient age, race, stage of cancer, comorbidities Annual Hospital Volume (% hospitals) 30 days mortality
1992-19966,421 with localized PCAverage number of procedures/yearUnit: PatientHospital - surgeon correlations<16 (69)0.5
Retrospective cohort403 hospitalsGoodness-of-fit: Not reported17–28 (17)0.5
Evidence: II-2CDiscrimination: Not reported29–50 (9)0.5
Quality: 0.6351–120 (5)0.5
60 days mortality
<160.6
17–280.6
29–500.6
51–1200.5
Yao, 1999 123 101,604 Medicare beneficiaries after radical prostatectomyMedicare claims dataPostoperative death within 30–90 days after radical prostatectomyLogistic regressionPatient age, race, comorbidities; surgeon specialty, hospital teaching status Hospital Volume
1991-1994Number of procedures/time of the studyUnit: Patient<38 (9/year)0.631.51 (1.25; 1.77)
Retrospective cohortGoodness-of-fit: Not reported39–74 (14/year)0.591.43 (1.17; 1.69)
Evidence: II-2CDiscrimination: Not reported75–140 (27/year)0.561.42 (1.16; 1.68)
Quality: 0.677>141 (36/year)0.391 (reference)
Wennberg, 1987 124 4,570 Medicare beneficiaries after prostatectomyMedicare claims data: 16 hospitalsPostoperative death within 90 days after prostatectomyLogistic regressionPatient age, comorbidities Annual Hospital Volume
1974-1977Number of procedures/time of the studyUnit: PatientHospital size and teaching status<401 (reference)
Retrospective cohortGoodness-of-fit: Not reported40–901.26 (0.69; 2.32)
Evidence: II-2CDiscrimination: Not reported>911.66 (0.95; 2.89)
Quality: 0.655

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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