REGULAR CONTENT
Introduction:
Following centralisation of major urological cancer surgery, median number of cases of RP per surgeon and per centre has increased in recent years but there remain significant differences in volume between surgeons/centres. The current analysis describes differences in RP practice between low, medium and high volume practices.
Methods:
Individual surgeons/units uploaded their data on RP to the BAUS Registry. Once extracted, data were transferred to an Access™ database for validation prior to analysis using Tableau™ software. Centres were defined as low (<50), medium (50-100) and high (>100) volume according to annual caseload. Surgeons were similarly grouped into low (<50) and high (>50) volume.
Results:
Details on 6,651 RP (Jan–Dec 2014) were uploaded from 157 consultants at 71 sites (87% of all RP in England). Table 1 demonstrates % of RP by volume, % undergoing lymph node dissection (LND) and % of latter that had extended LND (eLND).
|
| Centre | Surgeon | ||||
|
| Volume | LND | %eLND | Volume | LND | %eLND |
| LOW | 13.4% | 43% | 34.2% | 40.2% | 40% | 29% |
| MEDIUM | 28.1% | 34.8% | 19.8% | - | - | - |
| HIGH | 58.5% | 45% | 56% | 59.8% | 43% | 53.8% |
Only high volume robotic centres achieved a median length (LOS) of stay of 1d– other centres and lap RP had median LOS of 2d. Open RP - LOS 3d. The same effect was seen with surgeon volume. The majority of cases in high volume centres are robotically-assisted.
Conclusions:
Patients undergoing RP where surgeon and centre volumes are high are more likely to have an adequate LND, a robotically-assisted procedure and an optimal LOS.
Introduction:
Following centralisation of major urological cancer surgery, median number of cases of RP per surgeon and per centre has increased in recent years but there remain significant differences in volume between surgeons/centres. The current analysis describes differences in RP practice between low, medium and high volume practices.
Methods:
Individual surgeons/units uploaded their data on RP to the BAUS Registry. Once extracted, data were transferred to an Access™ database for validation prior to analysis using Tableau™ software. Centres were defined as low (<50), medium (50-100) and high (>100) volume according to annual caseload. Surgeons were similarly grouped into low (<50) and high (>50) volume.
Results:
Details on 6,651 RP (Jan–Dec 2014) were uploaded from 157 consultants at 71 sites (87% of all RP in England). Table 1 demonstrates % of RP by volume, % undergoing lymph node dissection (LND) and % of latter that had extended LND (eLND).
|
| Centre | Surgeon | ||||
|
| Volume | LND | %eLND | Volume | LND | %eLND |
| LOW | 13.4% | 43% | 34.2% | 40.2% | 40% | 29% |
| MEDIUM | 28.1% | 34.8% | 19.8% | - | - | - |
| HIGH | 58.5% | 45% | 56% | 59.8% | 43% | 53.8% |
Only high volume robotic centres achieved a median length (LOS) of stay of 1d– other centres and lap RP had median LOS of 2d. Open RP - LOS 3d. The same effect was seen with surgeon volume. The majority of cases in high volume centres are robotically-assisted.
Conclusions:
Patients undergoing RP where surgeon and centre volumes are high are more likely to have an adequate LND, a robotically-assisted procedure and an optimal LOS.