High-risk patients who undergo radical prostatectomy (RP) achieve better results in larger, busier hospitals, according to new study.

Researchers at Henry Ford Hospital (Detroit, MI, USA) identified 19,225 patients with prostate cancer who underwent RP from 1995 to 2005. They then examined outcomes for each patient within 30 days after surgery, and analyzed the effect of both hospital volume (HV) and surgeon volume (SV) in predicting complications, including blood transfusion, anastomotic stricture, long-term incontinence, and erectile dysfunction. In each case, the results were adjusted for age, race, the presence of other disease or disorders, marital and socioeconomic status, hospital’s surrounding population density, the surgical approach, and cancer grade.

The results showed that HV was more important than SV with regard to 30-day complication rates, especially for older, sicker patients. Both higher HV and higher SV led to lower rates of overall complications; they were also related to fewer respiratory and vascular complications. Both were associated with lower rates of anastomotic stricture, urinary incontinence, and erectile dysfunction, but higher SV led to less need for blood transfusion. The study was presented at the American Urological Association annual meeting, held during May 2012 in Atlanta (GA, USA).

“Hospital volume matters more where it’s about general delivery of care – for example, preventing complications and mortality. That probably depends on the quality of the hospital’s intensive care unit, the nursing staff, and other factors such as those, rather than on a specific surgeon’s skill,” said lead author Quoc-Dien Trinh, MD. “But risk of recurrence probably depends on the skill of the surgeon to remove the cancer properly, not on how good the hospital is.”

RP, in which the entire prostate gland and some of the surrounding tissue are surgically removed, is the most widely used treatment for prostate cancer. The surgery is highly complex and the results can have serious effects on quality of life, including incontinence and erectile dysfunction.

http://www.gzjiayumed.com/en/index.asp