Influence of hospital surgical volume of radical prostatectomy on quality of perioperative care

Yoshikatsu Nojiri, Kikuo Okamura, Yoshinori Tanaka, Hitoshi Yanaihara, Naoto Sassa, Ryohei Hattori, Jiroh Machida, Katsuyoshi Hashine, Tadashi Matsuda, Yoichi Arai, Seiji Naito, Tomonori Hasegawa

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Purpose: We investigated the relationships between hospital surgical volume, surgical outcome, care plans indicated in critical pathways and actual perioperative care using data from a nationwide survey for radical prostatectomy. Materials and methods: In this study, urologists from 155 hospitals in Japan cooperated in submitting the data of 4,029 patients who underwent radical prostatectomy in 2007, and the perioperative care plan in critical pathways. Of these, we analyzed data of 3,499 patients undergoing open radical prostatectomy and minimum incision endoscopic radical prostatectomy. Results: Increasing hospital volume was associated with decreased proportion of open radical prostatectomy (p < 0.001). As the hospital volume increased, surgical duration was significantly shorter (p < 0.001) and bleeding volume decreased (p < 0.004). Analyses of perioperative care suggested that low-volume hospitals (<15 patients annually) were likely to have longer care than medium-volume (15-29 patients per year) or high-volume (≥30 patients per year) hospitals, and the length of actual care was prolonged in the low-volume hospitals. Multivariate logistic regression analysis suggested that the occurrence of postoperative complications was significantly associated with surgeon's volume (p = 0.004), patient age (p = 0.001), preoperative anticoagulant therapy (p = 0.045), coexistent diabetes mellitus (p = 0.009), surgical duration (p = 0.002) and bleeding volume (p < 0.001), but not hospital volume. Conclusions: Urologists in high-volume hospitals appeared to attempt new types of surgery. Hospital surgical volume was strongly associated with the surgical duration, bleeding volume and planned and actual perioperative care; however, it was not associated with postoperative complications.

Original languageEnglish
Pages (from-to)898-904
Number of pages7
JournalInternational Journal of Clinical Oncology
Issue number5
Publication statusPublished - 2013 Oct


  • Hospital surgical volume
  • Perioperative care
  • Perioperative complications
  • Radical prostatectomy
  • Surgeons' volume

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology


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