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 2002-2008 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.