New England Section of the American Urological Association
NE Home NEAUA Home Past & Future Meetings Past & Future Meetings

Back to 2023 Abstracts


How Does Surgical Volume Of Surgeons Affect Surgical Outcomes In Partial Nephrectomy?
Jeffery Che-Wei Chang, MD1, Steven L. Chang, MD2.
1Harvard TH Chan School of Public Health, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA.

How does surgical volume of surgeons affect surgical outcomes in partial nephrectomy?
INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is an advanced surgical technique that treats renal tumors with optimal renal function preservation. Previous studies have shown that high volume surgeons are associated with better outcomes in advanced surgeries treating colon cancer and lung cancer. However, evidence with large sample size on the association between surgeon volume and outcome in partial nephrectomy is still lacking. We test the hypothesis that higher surgical volume is associated with better post operative outcomes.
METHODS:Patients receiving PN were captured from Premier Healthcare Database (PHD) using both ICD-9 55.4 and CPT code 50543 retrospectively from 2011 to 2020. High volume and low volume surgeons are defined as surgeons with amount of annual PNs above 75th percentile and below 25th percentile of all surgeons in the PHD. The primary outcome is Clavien-Dindo classification 3 or above (major complication). For the secondary outcomes we studied any complication, need for transfusion, admission to ICU, operation time, length of stay and total cost equivalent to dollars in 2020. We categorized operation time, length of stay and total costs into two categories: above and below annual median in the PHD. The analysis is done in 2 different groups within all PNs: open PN and robotic PN. Laparoscopic approach was excluded due to low numbers. Propensity score with inverse probability weighting was used to balance various baseline characteristics and we reported weighted odds ratio (OR) and 95% confidence interval. Since PHD is insurance claim-based database we cannot control for baseline tumor characteristics.
RESULTS:Due to changing annual surgical volume, the criterion for low volume surgeon is either 1 or 2 cases per year and for high-volume surgeon is more than 8 to 10 cases per year.High volume surgeon has roughly half the odds of developing major and any complication, around one-third the odds of admission to ICU, and less than half the odds of needing transfusion. Other outcomes such as operation time, length of stay and total cost are also significantly lower (table 1). By analyzing open and robotic PN, we can see the protective effect of high-volume surgeon on major complication and total cost is greater in the robotic approach (figure 1).
CONCLUSION:Partial nephrectomies by high-volume surgeons are associated with better outcomes. To further improve outcome, centralization to high-volume surgeons might be considered.


Back to 2023 Abstracts