Impact of hospital volume and surgeon volume on robot-assisted partial nephrectomy outcomes: a multicentre study

被引：54

作者：

Peyronnet, Benoit ^{[1
]}

Tondut, Lauranne ^{[1
]}

Bernhard, Jean-Christophe ^{[2
]}

Vaessen, Christophe ^{[3
]}

Doumerc, Nicolas ^{[7
]}

Sebe, Philippe ^{[4
]}

Pradere, Benjamin ^{[8
]}

Guillonneau, Bertrand ^{[4
]}

Khene, Zine-Eddine ^{[1
]}

Nouhaud, Francois-Xavier ^{[9
]}

Brichart, Nicolas ^{[10
]}

Seisen, Thomas ^{[2
]}

Alimi, Quentin ^{[4
]}

Beauval, Jean-Baptiste ^{[7
]}

Mathieu, Romain ^{[1
]}

Rammal, Adham ^{[10
]}

de la Taille, Alexandre ^{[11
]}

Baumert, Herve ^{[5
]}

Droupy, Stephane ^{[12
]}

Bruyere, Franck ^{[8
]}

Roupret, Morgan ^{[2
]}

Mejean, Arnaud ^{[6
]}

Bensalah, Karim ^{[1
]}

机构：

[1] Univ Rennes, Dept Urol, Rennes, France

[2] Univ Bordeaux, Dept Urol, Bordeaux, France

[3] La Pitie Salpetriere Hosp, Dept Urol, Paris, France

[4] Diaconnesses Hosp, Dept Urol, Paris, France

[5] St Joseph Hosp, Dept Urol, Paris, France

[6] Univ Paris 05, Dept Urol, Paris, France

[7] Univ Toulouse, Dept Urol, Toulouse, France

[8] Univ Tours, Dept Urol, Tours, France

[9] Univ Rouen, Dept Urol, Rouen, France

[10] Orleans Hosp, Dept Urol, Orleans, France

[11] Mondor Hosp, Dept Urol, Creteil, France

[12] Univ Nimes, Dept Urol, Nimes, France

来源：

BJU INTERNATIONAL | 2018年 / 121卷 / 06期

关键词：

kidney neoplasm; partial nephrectomy; volume-outcome; robot; LAPAROSCOPIC PARTIAL NEPHRECTOMY; PERIOPERATIVE OUTCOMES; SURGICAL VOLUME; COMPLICATIONS; MORTALITY; KIDNEY;

D O I：

10.1111/bju.14175

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To assess the impact of hospital volume (HV) and surgeon volume (SV) on perioperative outcomes of robot-assisted partial nephrectomy (RAPN). Patients and Methods All consecutive patients who underwent a RAPN from 2009 to 2015, at 11 institutions, were included in a retrospective study. To evaluate the impact of HV, we divided RAPN into four quartiles according to the caseload per year: low HV (<20/year), moderate HV (20-44/year), high HV (45-70/year), and very high HV (>70/year). The SV was also divided into four quartiles: low SV (<7/year), moderate SV (7-14/year), high SV (15-30/year), and very high SV (>30/year). The primary endpoint was the Trifecta defined as the following combination: no complications, warm ischaemia time (WIT) <25 min, and negative surgical margins. Results In total, 1 222 RAPN were included. The mean (SD) caseload per hospital per year was 44.9 (26.7) RAPNs and the mean (SD) caseload per surgeon per year was 19.2 (14.9) RAPNs. The Trifecta achievement rate increased significantly with SV (69.9% vs 72.8% vs 73% vs 86.1%; P < 0.001) and HV (60.3% vs 72.3% vs 86.2% vs 82.4%; P < 0.001). The positive surgical margins (PSM) rate (P = 0.02), length of hospital stay (LOS; P < 0.001), WIT (P < 0.001), and operative time (P < 0.001), all decreased significantly with increasing SV. The PSM rate (P = 0.02), LOS (P < 0.001), WIT (P < 0.001), operative time (P < 0.001), and major complications rate (P = 0.01), all decreased significantly with increasing HV. In multivariate analysis adjusting for HV and SV (model 3), HV remained the main predictive factor of Trifecta achievement (odds ratio [OR] 3.70 for very high vs low HV; P < 0.001), whereas SV was not associated with Trifecta achievement (OR 1.58 for very high vs low SV; P = 0.34). Conclusion In this multicentre study HV and SV both greatly influenced RAPN perioperative outcomes, but HV appeared to have a greater impact than SV.

引用

页码：916 / 922

页数：7

共 25 条

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