Martiniclinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Ann Surg Oncol. 2011 Mar;18(3):839-47. doi: 10.1245/s10434-010-1300-0. Epub 2010 Oct 16.
The relationship between provider volume and complication and transfusion rates in patients undergoing minimally invasive prostatectomy (MIRP) for prostate cancer has not been assessed. Temporal trends in MIRP annual surgical caseload (AC), impact of MIRP surgical experience (SE), and in-hospital complication and transfusion rates were evaluated.
Between 2002 and 2008, 2,666 patients in Florida underwent MIRP. Surgical experience was defined as the number of procedures performed from the beginning of the study until each individual MIRP. Multivariable logistic regression models using generalized estimating equations assessed the relationship between SE and in-hospital complication and transfusion rates.
Overall AC and SE ranged from 1-171 and 1-500, respectively. Between 2002 and 2005, 94-100% of surgeons were considered as low AC tertile (≤15 MIRP) vs. 76-82% between 2006 and 2008. For the same time periods, low AC tertile surgeons performed 46-100 and 27-32% of all MIRPs respectively. Multivariable logistic regression models revealed 51 and 68% lower complication rates in patients operated on by surgeons of intermediate (17-76 MIRPs) and high SE (≥77 MIRPs) relative to surgeons of low SE (≤16 MIRPs). Similarly, transfusion rates were 80 and 83% lower for the same groups.
Our study is the first to indicate that high SE reduces MIRP complication and transfusion rates. Despite this observation, even in the most contemporary study year, most MIRP surgeons (82%) were in the low AC tertile and contributed to as many as 32% of all MIRPs. These findings should be considered at informed consent.
在接受微创前列腺切除术（MIRP）治疗前列腺癌的患者中，医疗服务提供者的数量与并发症和输血率之间的关系尚未得到评估。本研究评估了 MIRP 年手术量（AC）的时间趋势、MIRP 手术经验（SE）的影响，以及住院并发症和输血率。
2002 年至 2008 年间，佛罗里达州有 2666 名患者接受了 MIRP。手术经验定义为从研究开始到每位患者接受 MIRP 的手术次数。使用广义估计方程的多变量逻辑回归模型评估 SE 与住院并发症和输血率之间的关系。
总体 AC 和 SE 范围分别为 1-171 和 1-500。2002 年至 2005 年间，94-100%的外科医生被认为是低 AC 三分位数（≤15 例 MIRP），而 2006 年至 2008 年间为 76-82%。在同一时期，低 AC 三分位数的外科医生分别完成了 46-100%和 27-32%的所有 MIRP。多变量逻辑回归模型显示，与低 SE（≤16 例 MIRP）的外科医生相比，中 SE（17-76 例 MIRP）和高 SE（≥77 例 MIRP）的外科医生的并发症发生率分别降低了 51%和 68%。同样，对于相同的组，输血率降低了 80%和 83%。
本研究首次表明，高 SE 降低了 MIRP 的并发症和输血率。尽管如此，即使在最近的研究年份，大多数 MIRP 外科医生（82%）仍处于低 AC 三分位数，完成了多达 32%的所有 MIRP。这些发现应在知情同意时予以考虑。
