Effects of Hospital Procedure Volume and Resident Training on Clinical Outcomes and Resource Use in Radical Retropubic Prostatectomy Surgery in the Department of Veterans Affairs

Tse Sun Ku, Christopher J. Kane, Saunak Sen, William G. Henderson, R. Adams Dudley, Brian A. Cason

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: In this retrospective cohort study we used data from the National Surgical Quality Improvement Program of the Veterans Health Administration to examine the effect of case volume and resident participation on radical retropubic prostatectomy outcomes. Materials and Methods: The study population included 5,736 patients who underwent radical retropubic prostatectomy in Veterans Administration hospitals between October 1, 2001 and September 30, 2004. Resource related outcomes included operative times and length of stay. Clinical outcomes included blood transfusion, complications, readmissions and reoperations. Hierarchical multivariate regression models were developed to predict outcomes. Risk adjustment was performed using patient chronic health factors and results of preoperative laboratory testing. Results: A total of 5,070 radical retropubic prostatectomy surgeries met inclusion criteria. After adjustment for case mix, academic training institutions had longer operative times (3.2 vs 2.4 hours, p <0.01) but shorter length of stay (3.4 vs 4.2 days, p <0.01). Surgery at academic institutions was not associated with greater risk of transfusion (p = 0.36), reoperation (p = 0.93), complications (p = 0.53) or readmissions (p = 0.97). However, among the academic institutions low vs high hospital radical retropubic prostatectomy volume was associated with longer length of stay (3.7 vs 3.1 days, p = 0.02) and higher transfusion rate (29.6% vs 18.2%, p = 0.02). Substantial clustering of outcomes at the hospital level was observed. Conclusions: Within the Veterans Administration system academic training institutions have longer operative times for radical retropubic prostatectomy, but shorter length of stay. Among the same institutions, high volume hospitals tend to have lower transfusion rates and shorter length of stay. Clustering of outcomes at the hospital level suggests that unmeasured institutional factors are key determinants of clinical and resource related outcomes.

Original languageEnglish (US)
Pages (from-to)272-279
Number of pages8
JournalJournal of Urology
Volume179
Issue number1
DOIs
StatePublished - Jan 1 2008

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Veterans
Prostatectomy
Length of Stay
United States Department of Veterans Affairs
Operative Time
Risk Adjustment
Reoperation
Cluster Analysis
Teaching
High-Volume Hospitals
Veterans Health
Veterans Hospitals
Quality Improvement
Blood Transfusion
Cohort Studies
Retrospective Studies
Health
Population

All Science Journal Classification (ASJC) codes

  • Urology

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Effects of Hospital Procedure Volume and Resident Training on Clinical Outcomes and Resource Use in Radical Retropubic Prostatectomy Surgery in the Department of Veterans Affairs. / Ku, Tse Sun; Kane, Christopher J.; Sen, Saunak; Henderson, William G.; Dudley, R. Adams; Cason, Brian A.

In: Journal of Urology, Vol. 179, No. 1, 01.01.2008, p. 272-279.

Research output: Contribution to journalArticle

Ku, Tse Sun ; Kane, Christopher J. ; Sen, Saunak ; Henderson, William G. ; Dudley, R. Adams ; Cason, Brian A. / Effects of Hospital Procedure Volume and Resident Training on Clinical Outcomes and Resource Use in Radical Retropubic Prostatectomy Surgery in the Department of Veterans Affairs. In: Journal of Urology. 2008 ; Vol. 179, No. 1. pp. 272-279.
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abstract = "Purpose: In this retrospective cohort study we used data from the National Surgical Quality Improvement Program of the Veterans Health Administration to examine the effect of case volume and resident participation on radical retropubic prostatectomy outcomes. Materials and Methods: The study population included 5,736 patients who underwent radical retropubic prostatectomy in Veterans Administration hospitals between October 1, 2001 and September 30, 2004. Resource related outcomes included operative times and length of stay. Clinical outcomes included blood transfusion, complications, readmissions and reoperations. Hierarchical multivariate regression models were developed to predict outcomes. Risk adjustment was performed using patient chronic health factors and results of preoperative laboratory testing. Results: A total of 5,070 radical retropubic prostatectomy surgeries met inclusion criteria. After adjustment for case mix, academic training institutions had longer operative times (3.2 vs 2.4 hours, p <0.01) but shorter length of stay (3.4 vs 4.2 days, p <0.01). Surgery at academic institutions was not associated with greater risk of transfusion (p = 0.36), reoperation (p = 0.93), complications (p = 0.53) or readmissions (p = 0.97). However, among the academic institutions low vs high hospital radical retropubic prostatectomy volume was associated with longer length of stay (3.7 vs 3.1 days, p = 0.02) and higher transfusion rate (29.6{\%} vs 18.2{\%}, p = 0.02). Substantial clustering of outcomes at the hospital level was observed. Conclusions: Within the Veterans Administration system academic training institutions have longer operative times for radical retropubic prostatectomy, but shorter length of stay. Among the same institutions, high volume hospitals tend to have lower transfusion rates and shorter length of stay. Clustering of outcomes at the hospital level suggests that unmeasured institutional factors are key determinants of clinical and resource related outcomes.",
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AB - Purpose: In this retrospective cohort study we used data from the National Surgical Quality Improvement Program of the Veterans Health Administration to examine the effect of case volume and resident participation on radical retropubic prostatectomy outcomes. Materials and Methods: The study population included 5,736 patients who underwent radical retropubic prostatectomy in Veterans Administration hospitals between October 1, 2001 and September 30, 2004. Resource related outcomes included operative times and length of stay. Clinical outcomes included blood transfusion, complications, readmissions and reoperations. Hierarchical multivariate regression models were developed to predict outcomes. Risk adjustment was performed using patient chronic health factors and results of preoperative laboratory testing. Results: A total of 5,070 radical retropubic prostatectomy surgeries met inclusion criteria. After adjustment for case mix, academic training institutions had longer operative times (3.2 vs 2.4 hours, p <0.01) but shorter length of stay (3.4 vs 4.2 days, p <0.01). Surgery at academic institutions was not associated with greater risk of transfusion (p = 0.36), reoperation (p = 0.93), complications (p = 0.53) or readmissions (p = 0.97). However, among the academic institutions low vs high hospital radical retropubic prostatectomy volume was associated with longer length of stay (3.7 vs 3.1 days, p = 0.02) and higher transfusion rate (29.6% vs 18.2%, p = 0.02). Substantial clustering of outcomes at the hospital level was observed. Conclusions: Within the Veterans Administration system academic training institutions have longer operative times for radical retropubic prostatectomy, but shorter length of stay. Among the same institutions, high volume hospitals tend to have lower transfusion rates and shorter length of stay. Clustering of outcomes at the hospital level suggests that unmeasured institutional factors are key determinants of clinical and resource related outcomes.

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