The volume/outcome relationship in urologic cancer surgery.

There is growing evidence in the literature of the association between higher hospital and surgeon volume and better outcomes from high-risk surgical procedures. A Medline search of the literature from 1966 to 2004 was performed using the keywords "outcome," "urology," "neoplasms," "volume," "hospital volume," "surgeon volume," "prostatectomy," "cystectomy," "nephrectomy," "prostate cancer," "bladder cancer," "kidney cancer," and "testis cancer." The relevant articles were reviewed and discussed in reference to each urologic cancer. Several studies have shown that higher hospital volume is associated with better outcomes for all urologic cancer surgeries. An association between postoperative mortality/morbidity and hospital and surgeon volumes was established. Individual surgeon volume is also a predictor of the quality and completeness of certain procedures such as radical prostatectomy. Long-term survival from cancer such as testicular cancer can be impacted by provider and institution volume. The evidence that highvolume hospitals have better outcomes from various types of urologic cancer surgery is increasing. The ultimate implication of these studies is that centralizing health care may yield better outcomes from urologic cancer surgeries. This is controversial and will have major health policy implications. Another approach would be to determine key factors that are the drivers behind better outcomes at high-volume centers and attempt to transfer those characteristics to lower-volume centers, thereby improving outcomes globally across all volume levels.