Hospital volume important to outcomes among older, sicker, Medicare patients treated by RP

A media release issued by Henry Ford Health System earlier today has a distinctly misleading headline that reads as follows: “Higher hospital volume more important than surgeon experience in outcome of prostate cancer surgery.” You need to read the content of the media release with care to understand that this headline is by no means an accurate summation of the results of the study referred.

Trinh et al. have looked carefully at two factors that have the potential to impact the overall quality of outcomes of Medicare patients undergoing radical prostatectomy (RP) for localized prostate cancer in the USA:

  • The number of operations done annually by individual surgeons (surgical volume or SV)
  • The number of operations done annually at individual hospitals (hospital volume or HV)

After a careful analysis of data from > 19,000 patients treated in the USA between 1995 and 2005, they come to the following conclusions:

  • That during that 10-year time frame, in men who were eligible for Medicare
    • Higher HV and higher SV both led to lower overall rates of complications.
    • Higher HV and higher SV were both related to fewer respiratory and vascular complications.
    • Higher SV led to less need for blood transfusions.
    • Higher HV and higher SV were both associated with lower rates of anastomotic stricture, urinary incontinence, and erectile dysfunction.

Based on these findings and others, Dr. Trinh is quoted as follows:

  • “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.”
  • “Risk of recurrence probably depends on the skill of the surgeon to remove the cancer properly, not on how good the hospital is.
  • “The main finding is that hospital volume matters more than surgeon volume with regard to 30-day complication rates, especially for older, sicker patients, [and] those at higher risk of complications.”

In other words, if you are a young and healthy patient, where you have the operation may be less important than who does the operation … because you are young and healthy and are therefore less likely to suffer from complications that require and depend for their outcomes on high quality, post-operative nursing care. Conversely, if you are an older man with co-morbid conditions, and you are therefore likely to need intensive care post-surgery, then the quality of that care may have greater impact on your outcome than the quality of the surgical care.

This is a very different set of conclusions than the single one posited in the headline from Henry Ford Health System.

The media release is based on data to be presented by Trinh et al. at the upcoming annual meeting of the American Urological association in Atlanta, starting on Sunday. Do be careful not to believe every headline you see about prostate cancer over the next few weeks without actually reading the information below the headline.

If you want to see the abstract of the paper to be presented by Trinh et al., please just click here and search fro abstract no. 688.

2 Responses

  1. Who, pray tell, has the data for SV and HV for RP? When will a layman have access to this valuable information?

  2. These data are all available through the SEER-Medicare database. I believe anyone can apply to access these data, but being able to make head or tail of them is a very different issue because they were never designed to be accessed by the general public, and so they won’t tell you a thing if you don’t know how to use them, and all the data are de-identified. I certainly don’t feel able to use these data to do direct research.

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