High surgeon radical prostatectomy volume linked to lower hospital charges

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Jun 26 2006

Increased procedure volume by both surgeon and hospital are associated with decreased mortality.

In the on-line version of European Urology, 2006 Dr. Ramirez and colleagues report that increased surgeon radical prostatectomy (RP) volume is associated with decreased hospital charges.

Using the State of Florida Inpatient Discharge Information Data File, 3,167 RPs were identified between January and December 1998. The average patient age was 63.5 years and 77% of patients were Caucasian. Of note, in 1997 the average surgical volume for RPs was 18.

Hospital charges ranged from $4,755 to $140,201 with a mean of $18,200. SV ranged from 2 to 162 with a mean of 68 RPs. The multivariate regression indicated that a SV increase corresponding to one RP is linked with a $25 decrease in hospital charges.

Application of this observation to a theoretical cohort of 1,000 patients suggests that one surgeon performing 50 RPs annually versus one performing 10 RPs results in $1,000 of increased hospital charges. This would correspond to a savings of $1,000,000 if applied to 1,000 patients.

Using the 1997 SV average of 18, 1,000 RPs performed by 10 surgeons with an annual volume of 200 instead of 18 would result in decreased charges of $4,550,000.

This study is limited by selection bias in the patient sample and does not include the variable of hospital volume. In addition, charges do not necessarily reflect true savings.

By Christopher P. Evans, MD

Reference:

Eur Urol. 2006 Jul;50(1):58-63. Epub 2006 Mar 27.