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Hospital volume and outcomes after radical prostatectomy: a national population-based study using patient-reported urinary continence and sexual function

Prostate Cancer and Prostatic Diseases volume 26, pages 264–270 (2023)Cite this article

Subjects

Abstract

Background

Improvements in short-term outcomes have been reported for hospitals with higher radical prostatectomy (RP) volumes. However, the association with longer-term functional outcomes is unknown.

Methods

All patients diagnosed with non-metastatic prostate cancer in the English NHS between 2014 and 2016 who underwent RP (N = 10,089) were mailed a survey ≥18 months after diagnosis. Differences in patient-reported urinary continence and sexual function (EPIC-26 on scale from 0 to 100) by hospital volume group (≤60, 61–100, 101–140, >140 RPs/year) were estimated using multilevel linear regression.

Results

Overall, 7702 men (76.3%) responded. There were no statistically significant differences in urinary continence (p = 0.08) or sexual function scores with increasing volume group (p = 0.2). When modelled as a linear function, we found a non-significant increase of 0.70 (95% CI −0.41 to 1.80; p = 0.22) in urinary continence and a significant increase of 1.54 (0.62–2.45; p = 0.001) in sexual function scores for a 100-procedure increase in hospital volume, which did not meet the threshold for a minimal clinically important difference (10–12 points). The results were similar for robotic-assisted RP (5529 men [71.8%]).

Conclusions

These results do not support further centralisation of RP services beyond levels in England where four in five hospitals perform >60 RPs/year.

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References

  1. Litwin MS, Lubeck DP, Henning JM, Carroll PR. Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol. 1998;159:1988–92.

    Article  CAS  PubMed  Google Scholar 

  2. Nossiter J, Sujenthiran A, Charman SC, Cathcart PJ, Aggarwal A, Payne H, et al. Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. Br J Cancer. 2018;118:489–94.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, et al. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol. 2012;61:679–85.

    Article  PubMed  Google Scholar 

  4. National Institute for Health and Care Excellence. Improving outcomes in urological cancers: cancer service guideline [CSG2]. 2002. https://www.nice.org.uk/guidance/csg2. Accessed Sep 2020.

  5. National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management (Clinical guideline [NG131]). 2019. https://www.nice.org.uk/guidance/NG131. Accessed Sep 2020.

  6. Leow JJ, Leong EK, Serrell EC, Chang SL, Gruen RL, Png KS, et al. Systematic review of the volume-outcome relationship for radical prostatectomy. Eur Urol Focus. 2018;4:775–89.

    Article  PubMed  Google Scholar 

  7. Xia L, Sperling CD, Taylor BL, Talwar R, Chelluri RR, Raman JD, et al. Associations between hospital volume and outcomes of robot-assisted radical prostatectomy. J Urol. 2020;203:926–32.

    Article  PubMed  Google Scholar 

  8. Nuttall M, Van Der Meulen J, Phillips N, Sharpin C, Gillatt D, McIntosh GR, et al. A systematic review and critique of the literature relating hospital or surgeon volume to health outcomes for 3 urological cancer procedures. J Urol. 2004;172:2145–52.

    Article  PubMed  Google Scholar 

  9. National Prostate Cancer Audit, Annual Report 2019: Results of the NPCA Prospective Audit in England and Wales for men diagnosed from 1 April 2017 - 31 March 2018 (published January 2020). 2020, The Royal College of Surgeons of England: London. https://www.npca.org.uk/reports/npca-annual-report-2019/. Accessed Sep 2020.

  10. National Disease Registration Service. English Cancer Registry data. https://www.ndrs.nhs.uk/. Accessed Sep 2020.

  11. National Health Service. Hospital episode statistics. http://www.hesonline.nhs.uk. Accessed Sep 2020.

  12. Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology. 2010;76:1245–50.

    Article  PubMed  Google Scholar 

  13. Skolarus TA, Dunn RL, Sanda MG, Chang P, Greenfield TK, Litwin MS, et al. Minimally important difference for the expanded prostate cancer index composite short form. Urology. 2015;85:101–5.

    Article  PubMed  Google Scholar 

  14. University Hospital Association. https://www.universityhospitals.org.uk/. Accessed Sep 2020.

  15. John Wiley & Sons. TNM classification of malignant tumours. In: Brierley, JD, Gospodarowicz MK, Wittekind C, editors. 8th ed. New York: John Wiley & Sons; 2016.

  16. National Prostate Cancer Audit, Third Year Annual Report - Results of the NPCA Prospective Audit and Patient Survey. (published 13 December 2016). 2016, The Royal College of Surgeons of England: London. https://www.npca.org.uk/reports/npca-annual-report-2016/. Accessed September 2020.

  17. Smith T, Noble M, Noble S, Wright G, McLennan D, Plunkett E. The English indices of deprivation. London: Department for Communities and Local Government; 2015.

  18. Armitage JN, van der Meulen J. Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score. Br J Surg. 2010;97:772–81.

    Article  CAS  PubMed  Google Scholar 

  19. The University of Michigan. Scoring Instructions for the Expanded Prostate cancer Index Composite Short Form (EPIC-26). Ann Arbor, Michigan: University of Michigan; 2002.

  20. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30:377–99.

    Article  PubMed  Google Scholar 

  21. Rubin DB. Multiple imputation for nonresponse in surveys. New York: John Wiley and Sons; 1987.

  22. StataCorp, STATA statistical software. College Station TX: Stata Corporation; 2015.

  23. Groeben C, Koch R, Baunacke M, Wirth MP, Huber J. High volume is the key for improving in-hospital outcomes after radical prostatectomy: a total population analysis in Germany from 2006 to 2013. World J Urol. 2017;35:1045–53.

    Article  PubMed  Google Scholar 

  24. Gershman B, Psutka SP, McGovern FJ, Dahl DM, Tabatabaei S, Gettman MT, et al. Patient-reported functional outcomes following open, laparoscopic, and robotic assisted radical prostatectomy performed by high-volume surgeons at high-volume hospitals. Eur Urol Focus. 2016;2:172–9.

    Article  PubMed  Google Scholar 

  25. Pompe RS, Tian Z, Preisser F, Tennstedt P, Beyer B, Michl U, et al. Short- and long-term functional outcomes and quality of life after radical prostatectomy: patient-reported outcomes from a tertiary high-volume center. Eur Urol Focus. 2017;3:615–20.

    Article  PubMed  Google Scholar 

  26. Cathcart P, Sridhara A, Ramachandran N, Briggs T, Nathan S, Kelly J. Achieving quality assurance of prostate cancer surgery during reorganisation of cancer services. Eur Urol. 2015;68:22–9.

    Article  PubMed  Google Scholar 

  27. Coughlin GD, Yaxley JW, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol. 2018;19:1051–60.

    Article  PubMed  Google Scholar 

  28. Yaxley J, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388:1057–66.

    Article  PubMed  Google Scholar 

  29. Health cover UK market report. 12th ed. LaingBuisson: London; 2015.

  30. Trieu D, Ju IE, Chang SB, Mungovan SF, Patel MI. Surgeon case volume and continence recovery following radical prostatectomy: a systematic review. ANZ J Surg. 2021;91:521–9.

    Article  PubMed  Google Scholar 

  31. Nuttall M, van der Meulen J, Phillips N, Sharpin C, Gillatt D, McIntosh G, et al. A systematic review and critique of the literature relating hospital or surgeon volume to health outcomes for 3 urological cancer procedures. J Urol. 2004;172:2145–52.

    Article  PubMed  Google Scholar 

  32. Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res. 1987;22:157–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Aggarwal A, Lewis D, Mason M, Purushotham A, Sullivan R, van der Meulen J. Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study. Lancet Oncol. 2017;18:1445–53.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Aggarwal A, Lewis D, Charman SC, Mason M, Clarke N, Sullivan R, et al. Determinants of patient mobility for prostate cancer surgery: a population-based study of choice and competition. Eur Urol. 2018;73:822–5.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank all men who returned the survey questionnaires and Quality Health (www.quality-health.co.uk) for administering the survey. We thank NHS staff for their support in collecting the clinical data. The cancer registry data used for this study are based on information collected and quality assured by Public Health England’s National Cancer Registration and Analysis Service (www.ncras.nhs.uk), part of Public Health England. Hospital Episode Statistics data were made available by NHS Digital (www.digital.nhs.uk). JN had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Data are not available to other researchers as it uses existing national datasets.

Author information

Author notes

  1. These authors jointly supervised this work: Jan van der Meulen, Noel W. Clarke, Paul Cathcart.

Authors and Affiliations

  1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

    Julie Nossiter, Melanie Morris, Thomas E. Cowling, Matthew G. Parry & Jan van der Meulen

  2. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK

    Julie Nossiter, Melanie Morris, Thomas E. Cowling, Matthew G. Parry & Arunan Sujenthiran

  3. Department of Radiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Ajay Aggarwal

  4. Department of Cancer Epidemiology, Population, and Global Health, King’s College London, London, UK

    Ajay Aggarwal

  5. Department of Oncology, University College London Hospitals NHS FoundatIon Trust, London, UK

    Heather Payne

  6. Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Salford, UK

    Noel W. Clarke

  7. Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Paul Cathcart

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Contributions

Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results: JN, MM, TEC, MGP, AS, AA, HP, JvM, NWC and PC. Drafted or revised the manuscript: JN, MM, TEC, MGP, AS, AA, HP, JvM, NWC and PC. Approved the final version: JN, MM, TEC, MGP, AS, AA, HP, JvM, NWC and PC. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JN, MM, TEC, MGP, AS, AA, HP, JvM, NWC and PC. JN had full access to the data in the study and final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Julie Nossiter.

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Competing interests

JN, MM, TEC, MGP, AS, AA, HP, JvM, NWC and PC are members of the Project Team of the National Prostate Cancer Audit (www.npca.org.uk) which is commissioned by the Healthcare Quality Improvement Partnership (www.hqip.org.uk) as part of the National Clinical Audit and Patient Outcomes Programme, and funded by NHS England and the Welsh Government. Neither HQIP nor NHS England or the Welsh Government had any involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The researchers had full independence from the Healthcare Quality Improvement Partnership. JvM reports a contract with the Healthcare Quality Improvement Partnership for the provision of the National Prostate Cancer Audit (www.npca.org.uk) funded by the Healthcare Quality Improvement Partnership (www.hqip.org.uk). HP was supported by the University College London Hospitals/University College London Comprehensive Biomedical Research Centre. MGP was partly supported by the NHS National Institute for Health Research through an Academic Clinical Fellowship (ACF-2014-20-002). The views expressed in this article are those of the authors and not necessarily those of the NHS or the Department of Health and Social Care. NWC has attended and received honoraria for advisory boards, travel expenses to medical meetings, and served as a consultant for AstraZeneca, Astellas, Bayer, Janssen, Sanofi Aventis, Takeda, Ipsen and Ferring.

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Nossiter, J., Morris, M., Cowling, T.E. et al. Hospital volume and outcomes after radical prostatectomy: a national population-based study using patient-reported urinary continence and sexual function. Prostate Cancer Prostatic Dis 26, 264–270 (2023). https://doi.org/10.1038/s41391-021-00443-z

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