Impact of surgeon case volume on postoperative complications, mortality, medical costs and length of hospital stay after transurethral resection of the prostate (TURP): A nationwide population-based study in Taiwan

Purpose: There were numerous volume-outcome studies during the previous decade indicating that high surgeon case volume provides better outcome in high risk operations. Conversely, surgeon case volume may play little role in some well-established operations, such as transurethral resection of the prostate (TURP), the standard surgical procedure for benign prostate hyperplasia (BPH) since 1920s. We investigate the impact of surgeon case volume on in-hospital mortality, postoperative complications, blood transfusion rate, length of hospital stay and medical expense in TURP.

Materials and Methods: This study used data from the National Health Insurance Research Database (NHIRD), which is provided by the Bureau of National Health Insurance in Taiwan. The study sample will be identified from the database by ICD-9-CM code from 2002 to 2012. The sample of 3381 patients who had undergone TURP for the first time was divided into low (estimated 33 cases per year or less), medium (estimated 33 to 51 cases per year) and high-volume (estimated 52 or more cases per year) surgeon groups equally. The correlations of all patient, surgeon and hospital variables with the outcomes and medical expense of TURP were analyzed.

Results: A total of 3381 patients underwent TURP for the first time by 430 surgeons in 185 hospitals from 2002 to 2012. The overall in-hospital mortality rate was 0.18% (6 of 3381 patients) and was not significantly different among groups. The blood transfusion rates of the low, medium and high volume surgeon group were 0.35%, 0.53%, and 0.44%, respectively (p = 0.815), and postoperative complication rates were 1.16%, 0.98% and 1.08% respectively (p = 0.932). However, TURP performed by high-volume surgeons cost 6.2% less ($1186 vs $1265, p = 0.0004) and resulted in shorter hospital stay (4.58 vs 5.11 days, p < 0.0001) compared with low-volume surgeons.

Conclusion: According to preliminary results, surgeon volume was associated with lower medical costs and shorter hospital stay after TURP. Surgeon volume, however, was not an independent predictor of mortality, blood transfusion rates and postoperative complication rates.