An observational study of volume–outcome effects for robot‐assisted radical prostatectomy in England

Abstract

To investigate volume-outcome relationships in robot-assisted radical prostatectomy (RARP) for cancer using data from the Hospital Episodes Statistics (HES) database for England. Materials and MethodsData for all adult, elective RPs for cancer during the period January 2013-December 2018 (inclusive) were extracted from the HES database. The HES database records data on all National Health Service (NHS) hospital admissions in England. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (laparoscopic, open or robot-assisted), hospital length of stay (LOS), emergency readmissions, and deaths. Multilevel modelling was used to adjust for hierarchy and covariates. ResultsData were available for 35 629 RPs (27 945 RARPs). The proportion of procedures conducted as RARPs increased from 53.2% in 2013 to 92.6% in 2018. For RARP, there was a significant relationship between 90-day emergency hospital readmission (primary outcome) and trust volume (odds ratio [OR] for volume decrease of 10 procedures: 0.99, 95% confidence interval [CI] 0.99-1.00; P = 0.037) and surgeon volume (OR for volume decrease of 10 procedures: 0.99, 95% CI 0.99-1.00; P = 0.013) in the previous year. From lowest to highest volume category there was a decline in the adjusted proportion of patients readmitted as an emergency at 90 days from 10.6% (0-49 procedures) to 7.0% (≥300 procedures) for trusts and from 9.4% (0-9 procedures) to 8.3% (≥100 procedures) for surgeons. LOS was also significantly associated with surgeon and trust volume, although 1-year mortality was associated with neither. ConclusionsThere is evidence of a volume-outcome relationship for RARP in England and minimising low-volume RARP will improve patient outcomes. Nevertheless, the observed effect size was relatively modest, and stakeholders should be realistic when evaluating the likely impact of further centralisation at a population level.

Regional variations and deprivation are linked to poorer access to laparoscopic and robotic colorectal surgery: a national study in England

“…These findings fit the national picture of a large increase in laparoscopic surgery over the last decade, with recent increases in robotic surgery [ 19 , 20 , 27 ]. HES-linked data in England has been used to show an increase in robotic surgery for urological [ 29 – 31 ] and gynaecological [ 21 ] surgery over the last decade. Uptake of robotics in colorectal surgery has been shown to be linked to uptake in these specialties, likely tied to institutional access to a robotic platform [ 22 ].…”

“…Studies demonstrate higher volume centres have lower readmission rates after MIS [ 27 , 31 ], with decreased costs [ 35 ]. NHS Scotland has invested £20 million to acquire 10 surgical robots nationally [ 36 ] and the Welsh Government has provided £4.2 million in funding (alongside £13.35 million from health boards) to create an ‘All-Wales Robotic Assisted Surgery Network’ [ 37 ].…”

The Getting It right First Time (GIRFT) programme in urology; rationale and methodology

“…The GIRFT urology programme has sought to understand the impact of its interventions [17,[19][20][21][22][23]. Priority areas for evaluation include:…”

“…The GIRFT urology programme has sought to understand the impact of its interventions [17,19–23]. Priority areas for evaluation include: Whether units have been able to adopt GIRFT recommendations Understanding the enablers and barriers to change Understanding any unexpected positive or adverse outcomes due to implemented recommendations Modelling the climate impact of GIRFT‐advocated practices. …”

Robotics in Urology: No More Shadows?

“…The increasing availability of PSA and prostate cancer diagnoses [4], with 1.3 million new cases of prostate cancer worldwide [5] and 140,000 radical prostatectomies performed annually in the USA alone [2], along with the accessibility to robotic platforms [6], combined to make RARP a popular and safe form of cancer surgery.…”