The Impact of Hospital Volume on Postoperative Complications Following Robot-Assisted Partial Nephrectomy

Abstract

High-volume hospitals are associated with decreased blood transfusions and complications. With the recognition that high-volume RAPN hospitals are independently associated with improved clinical outcomes, further studies should be performed to determine the role of the hospital and surgeon volume thresholds in the performance of RAPN.

Hospital volume and outcomes of robot‐assisted partial nephrectomy

“…The lower odds of PLOS in the higher‐volume hospitals is consistent with a previous study . PLOS can be considered as a proxy for inpatient complications, which were also more likely to be seen in lower‐volume hospitals . Although discharge practice may be different across various hospitals and surgeons, higher odds of PLOS would be very likely to increase the final overall cost .…”

“…Hospital volume categories were determined according to the following criteria: very low volume, 1-7 cases (n = 3 693); low volume, 8-14 cases (n = 3 719); medium volume, 15-23 cases (n = 3 833); high volume, 24-43 cases (n = 3 649); and very high volume, ≥44 cases (3 830). The median (interquartile range) hospital volume increased from 15 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Baseline characteristics of the cohort are summarized in Table 1. The unadjusted outcome comparison across the strata of hospital volume is shown in Fig.…”

“…Based on our results, centralization of RAPN to high‐volume hospitals may provide superior peri‐operative outcomes and potentially better oncological control. When taken together with previous studies, centralization may also decrease the procedure‐related cost in the overall population ; however, robot‐assisted surgery has expanded rapidly, and some degree of decentralization has already occurred in RARP . It is unclear, therefore, whether centralization of RAPN would happen naturally as with radical cystectomy, or whether RAPN would eventually decentralize as has RARP .…”

“…To our knowledge, there have been only two studies that evaluated the volume–outcome associations in RAPN; one on hospital volume and one on surgeon volume. Monn et al used the NIS data (2009–2011) and categorized hospital volume into high, medium and low. Tumour characteristics (size, grade, pathology) are not available in the NIS database and their study mainly focused on in‐hospital complications.…”

Analysis of the Transperitoneal Approach to Robot-Assisted Laparoscopic Partial Nephrectomy for the Treatment of Anterior and Posterior Renal Masses

“…Indeed, it has been reported that complication rates for robotic-assisted PN are lower at high-volume centers. 20 WIT has also been found to inversely correlate with surgeon volume, across multiple surgeons and institutions. 21 TPRPN is a more familiar modality for many surgeons 12 and is the preferred approach for anterior tumors.…”