Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore.
Eur Urol Focus. 2018 Dec;4(6):775-789. doi: 10.1016/j.euf.2017.03.008. Epub 2017 Apr 6.
Radical prostatectomy (RP) is one of the most complex urological procedures performed. Higher surgical volume has been found previously to be associated with better patient outcomes and reduced costs to the health care system. This has resulted in some regionalization of care toward high-volume facilities and providers; however, the preponderance of RPs is still performed at low-volume institutions.
To provide an updated systematic review of the association of hospital and surgeon volume on patient and system outcomes after RP, including robot-assisted RP.
A systematic review of literature was undertaken, searching PubMed (1959-2016) for original articles. Selection criteria included RP, hospital and/or surgeon volumes as predictor variables, categorization of hospital and/or surgeon volumes, and measurable end points.
Overall 49 publications fulfilled the inclusion criteria. Most of the studies demonstrated that higher-volume surgeries are associated with better outcomes including reduced mortality, morbidity, postoperative complications, length of stay, readmission, and cost-associated factors. The volume-outcome relationship is maintained in robotic surgery. Eleven studies assessed hospital and surgeon volume simultaneously, and findings reflect that neither is an independent predictor variable affecting outcomes. The studies varied in how volume cutoffs were categorized as well as how the volume-outcome relationship was methodologically evaluated.
Contemporary evidence continues to support the relationship between high-volume surgeries with improved RP outcomes. Recent studies demonstrate that the volume-outcome relationship applies to robot-assisted RP and may be applied for potential cost savings in health care. An increase in the number of international studies suggests reproducibility of the association. Although regionalization of surgical care remains a contentious issue, there is an increasing body of evidence that short-term outcomes are improved at high-volume centers for RP.
This systematic review of the latest literature found that higher surgical volume was associated with improved outcomes for radical prostatectomy.
根治性前列腺切除术（RP）是泌尿外科中最复杂的手术之一。之前的研究发现，较高的手术量与患者预后的改善和医疗保健系统成本的降低有关。这导致了一些区域性的高容量设施和服务提供者的护理；然而，绝大多数 RP 仍然在低容量的机构进行。
提供一个最新的系统综述，探讨 RP 后医院和外科医生手术量与患者和系统结果的关系，包括机器人辅助 RP。
对文献进行了系统回顾，在 PubMed（1959-2016）上搜索了原始文章。选择标准包括 RP、医院和/或外科医生的数量作为预测变量、医院和/或外科医生数量的分类以及可衡量的终点。
共有 49 篇文献符合纳入标准。大多数研究表明，高容量手术与更好的结果相关，包括降低死亡率、发病率、术后并发症、住院时间、再入院率和成本相关因素。机器人手术中也存在这种体积-结果关系。有 11 项研究同时评估了医院和外科医生的数量，结果表明两者都不是影响结果的独立预测变量。这些研究在如何分类体积截止值以及如何从方法学上评估体积-结果关系方面存在差异。
当代证据继续支持高容量手术与改善 RP 结果之间的关系。最近的研究表明，体积-结果关系适用于机器人辅助 RP，并可能为医疗保健节省潜在成本。越来越多的国际研究表明，这种关联具有可重复性。尽管外科手术的区域化仍然是一个有争议的问题，但越来越多的证据表明，高容量中心的短期结果在 RP 中得到改善。
本系统综述最新文献发现，较高的手术量与根治性前列腺切除术的改善结果相关。
