Systematic review on volume-outcome relationship in radical prostatectomy
Leong, Eugene Kwong Fei
Date of Issue2017-08-31
Lee Kong Chian School of Medicine (LKCMedicine)
Background: Radical prostatectomy (RP) is one of the most complex urological procedures performed. A 2013 systematic review demonstrated that higher annual volume of cases undertaken by both surgeons and hospitals is associated with better short- and long-term outcomes. Objectives: To provide an updated systematic review of the association of hospital and surgeon volume on outcomes after RP. Search strategy: A systematic review of literature was undertaken, searching PubMed (1959-2016) for original articles. Selection criteria consisted RP, hospital and/or surgeon volumes as predictor variables, categorisation of hospital and/or surgeon volumes and measurable end-points. Evidence synthesis: The search terms used yielded 3,859 results, from which 49 publications were included. Most studies were retrospective and done using population-based or institutional databases. 11 studies examined both hospital and surgeon volumes, while the remainder investigated either in isolation. Most studies supported the association of increasing hospital or surgeon volume with improved RP outcomes, such as mortality, complications, costs and length-of-stay. A small proportion of studies did not show any significance between the two. Large variation existed between the studies with regard to volume cut-offs for evaluation of the volume-outcome relationship. Conclusion: Contemporary evidence continues to support the volume-outcome relationship for RP. Increasing studies outside of the US suggest reproducibility of this volume-outcome relationship around the world.
Final Year Project (FYP)