Older, sicker, high-risk patients who undergo one of the most common treatments for prostate cancer get better results in larger, busier hospitals, according to new research by Henry Ford Hospital.
In such cases, the same research showed the experience level of the surgeon doing the procedure mattered somewhat less than the hospital setting.
The results, based on data gathered throughout the U.S., will be presented this week at the American Urological Association Annual Meeting in Atlanta.
It is both intuitive - "practice makes perfect" - and has been well known and accepted in the medical community, that both higher hospital volume (the number of occupied beds) and higher surgeon volume (the number of operations performed) lead to better surgical results.
But the new study is the first to test that conclusion in a head-to-head comparison of the two factors on radical prostatectomy (RP).
"There's a clear and distinct relation between surgeon and hospital volume and outcome - the more you do the better the results," says Quoc-Dien Trinh, M.D., a Fellow at Henry Ford Hospital's Vattikuti Urology Institute and lead author of the study.
"I think the novelty of this research is that there are not a lot of studies that have compared hospital to surgeon volume. When does hospital volume matter more, and when does surgeon volume?"
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 second most common cancer in American men older than 45. The surgery is highly complex and the results can have serious effects on quality of life, including incontinence and erectile dysfunction.
Drawing on data from the National Cancer Institute's Surveillance, Epidemiology and End Results Program (SEER), the researchers identified 19,225 Medicare patients with prostate cancer who underwent RP from 1995 to 2005. Then, looking at the outcome for each patient within 30 days after surgery, they analyzed the effect of both hospital volume (HV) and surgeon volume (SV) in predicting complications, including blood transfusion, anastomotic stricture (scarring and narrowing of incision lines), long-term incontinence, and erectile dysfunction.