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The hospital provider for south east region in Norway asked NOKC to update our previous systematic review on patient volume and quality of care to assess new publications for prostate cancer
We searched for publications in Medline for the period January 2006 to August 2008, which extends our previous search to cover the period from August 2008 back to 1990. In this update we included six new studies; together with two studies from the previous review we now have 8 relevant studies on the relationship between hospital or surgeon volume and quality of care for prostate cancer.
In large the studies are mostly based on analyses of administrative databases covering a period before year 2000. Included patients were treated with open surgery and are mostly elderly patients. There are some overlapping studies due to multiple publications from the same databases. Seven of eight included studies were from the US.
- We found no study that assessed the impact of patient volume on disease free or overall survival. One study reported a correlation between hospital volume and though En studie fant korrelasjon til sykehusvolum basert på surrogat-mål (administrativ informasjon om supplerende behandling). Det er ingen resultater som viser sammenheng mellom volum og overlevelse.
- Mortality following prostate cancer surgery is low (0,5% or less in included studies). Some studies reported lower mortality rates for high volume hospitals, but these findings were not consistent. The thresholds for high volume hospital ranged from 20 – 60 procedures per year, and did not differ be-tween studies that found or not found an association between volume and 30 day mortality.
- Postoperative complications were associated with hospital volume and lower in high volume hospitals. Few studies assessed long term complications.
- Functional results. Only one study reported on functional data. Long term incontinence was related to surgeon volume, but not hospital volume.
Surgery for prostate cancer has increased over the later year, but is also centralised to fewer hospitals. The median annual number per hospital was 1o procedures in 2003 and 34 in 2007. Still there is a huge variation in the annual number per hospital.