MEMORANDUM FOR: Science Writers and Editors on the Journal Press List

Performing Large Numbers of Prostate Surgeries is Associated With Better Outcomes and Can Lead to Shorter Hospital Stays

November 10, 1999 (EMBARGOED FOR RELEASE 4 P.M. EDT November 16)

Julianne Chappell, Executive Editor, Dan Eckstein, (301) 986-1891, ext. 112

Hospitals that perform more prostate surgeries have better outcomes and shorter patient stays, and increasing the number of surgeries a hospital performs can shorten the average stay while maintaining the quality of care.

These findings, which have both economic and health implications, are presented by Siu-Long Yao, M.D., Merck Research Laboratories, Rahway, N.J., and Grace Lu-Yao, Ph.D., HealthStat, Princeton, N.J., in the November 17 issue of the Journal of the National Cancer Institute.

Prostate cancer afflicts one in six U.S. men over the age of 35 years. Radical prostatectomy (surgical removal of the prostate) is the most common form of treatment for this disease, and more than 25,000 of these procedures are performed annually in the Medicare population alone. Nonetheless, little was known about the relationship between the number of procedures performed, short-term outcomes, and length of stay. To understand these relationships, the authors analyzed Medicare claims data on 101,604 prostatectomies performed from 1991 through 1994. The median age of the men studied was 69 years.

In this study, hospitals were classified as high (more than 141 cases during the study period), medium-high (75-140), medium-low (39-74), or low (less than 39) volume. Length of hospital stay, mortality, surgical complications, and readmissions over a 30-day follow-up period were abstracted from the data.

The authors found that men treated at low-volume (as compared with high-volume) hospitals had a 30% higher relative risk of readmission, a 43% higher relative risk of serious complications, and a 51% higher relative risk of mortality. The mean length of stay in hospitals with low volumes of patients undergoing prostatectomies was 9% longer than the stay in hospitals with high volumes. Hospitals that experienced a relative increase in prostatectomy volume during the study period had a 57% greater reduction in length of a patient's stay compared with hospitals with a relative decrease in volume. Reductions in length of stay were most marked when hospitals performing the fewest number of surgeries were able to increase the number of cases performed. Remarkably, reductions in length of stay achieved through increases in surgical volume did not adversely affect the frequency of mortality, complications, or readmission.

This study suggests that, at least for prostatectomies, decreasing the length of hospital stay through increased surgical volume is not accompanied by adverse patient outcomes. Application of this principle may greatly reduce costs, while maintaining or improving the quality of health care.

In an editorial, Arnold Potosky, Ph.D., and Joan Warren, Ph.D., National Cancer Institute, explore whether volume-outcomes effects reported in the article are useful indicators of quality of care. They note that the study did not assess surgeon volume or referral patterns, which may be as important to outcomes as hospital volume. In addition, they observe that the magnitude of the differences in outcomes by volume was small and may have limited clinical meaning. They emphasize that, until more research is available on the long-term outcomes of prostatectomy compared with other treatment strategies, perhaps the best indicator of quality of care may be the extent to which men are fully informed of their treatment options and associated long-term outcomes.

Contact: Phil Gimson (215) 652-5864; fax (215) 652-4283. Editorial: NCI Press Office, (301) 496-6641. (Note: The media contact for the editorial is the NCI Press Office because the authors are on the NCI staff.)

Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.



             
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