Centralization of radical prostatectomy in the United States.

Anderson CB, Penson DF, Ni S, Makarov DV, Barocas DA.

Source

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA. c.anderson@vanderbilt.edu

Abstract

PURPOSE:

Radical prostatectomy is a common treatment for organ confined prostate cancer and its use is increasing. We examined how the increased volume is being distributed and what hospital characteristics are associated with increasing volume.

MATERIALS AND METHODS:

We identified all men age 40 to less than 80 years who underwent radical prostatectomy for prostate cancer from 2000 to 2008 in the NIS (Nationwide Inpatient Sample) (586,429). Ownership of a surgical robot was determined using the 2007 AHA (American Hospital Association) Annual Survey. The association between hospital radical prostatectomy volume and hospital characteristics, including ownership of a robot, was explored using multivariate linear regression.

RESULTS:

From 2000 to 2008 there was a 74% increase in the number of radical prostatectomies performed (p = 0.05) along with a 19% decrease in the number of hospitals performing radical prostatectomy (p <0 .001="" 2007.="" a="" an="" analysis="" and="" annual="" associated="" bed="" greater="" higher="" hospital="" in="" including="" increase="" large="" location="" multivariate="" of="" on="" ownership="" p="" presence="" prostatectomy="" radical="" resulting="" robot="" several="" size="" status="" teaching="" the="" urban="" variables="" volume.="" volume="" were="" with="" year="">

CONCLUSIONS:

Use of radical prostatectomy increased significantly between 2000 and 2008, most notably after 2005. The increase in radical prostatectomy resulted in centralization to select hospitals, particularly those in the top radical prostatectomy volume quartile and those investing in robotic technology. Our findings support the hypothesis that hospitals with the greatest volume increases are specialty centers already performing a high volume of radical prostatectomy procedures.
Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.