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Abstract

Williams et al found that higher surgeon volumes were associated with lower costs for radical prostatectomy when operating at high or intermediate volume hospitals. Surgeries at higher volume hospitals did not reduce costs for low and intermediate volume surgeons. This suggests that the surgeon is the main determinant of cost and that even efficient hospitals cannot compensate for lower surgeon experience.When extrapolated nationally the net savings are approximately $29 million. While the savings are not impressive compared with the multiple billion dollars of costs for prostate cancer care annually, there are many reasons for patients to search for surgeons with more experience. Several studies have demonstrated that rates of postoperative and late urinary complications are significantly reduced if the procedure is performed at a high volume hospital and by a surgeon who performs a high number of such procedures (reference 6 in article). Furthermore, higher volume surgeons have lower rates of positive surgical margins after radical prostatectomy. 1 Despite these advantages, instituting policies that encourage referral to high volume surgeons has many obstacles and currently are driven by patient demand. REFERENCE 1. Eastham JA, Kattan MW, Riedel E et al: Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol 2003; 170: 2292.