The impact of surgical experience on total hospital charges for minimally invasive prostatectomy: a population-based study

OBJECTIVE To evaluate the relationship between surgical volume (SV) and total hospital charges in patients undergoing minimally invasive radical prostatectomy (MIRP) for treatment of localized prostate cancer. PATIENTS AND METHODS Within the Florida Hospital Inpatient Datafile, 2666 men who were treated with MIRP for prostate cancer between 20022008 were identified. The SV was defined in two ways: annual caseload (AC) and each surgeons experience (SE) defined as the total number of procedures performed since entering the study until the time of each MIRP. RESULTS The mean and median charges were respectively 38 852 and 31 511 US Dollars. AC ranged from 1-171 and SE varied from 1-500. Overall, 75.7 to 94% of surgeons were in the lowest AC tertile and 27 to 66% of patients were operated by low AC tertile surgeons. After stratification according to AC tertiles, median charges were 41 564; 33 395 and 26 608 US Dollar for respectively low intermediate and high AC tertile categories. Multivariable logistic regression models with generalized estimating equations revealed that the probability of charges above the median was reduced by respectively 38 and 68% in patients operated by intermediate SE (17-76 MIRPs) or high SE tertile (>= 77 MIRPs) surgeons vs. low SE tertile (<= 16 MIRPs) surgeons. CONCLUSIONS High surgical experience reduces MIRP total hospital charges. Despite this observation, even in 2008, 82% of MIRP surgeons were in the lowest AC tertile and contributed to 32% of all MIRPs.