The Effect of Hospital and Surgeon Volume on Racial Differences in Recurrence-Free Survival After Radical Prostatectomy

Objective: This Study investigates associations between hospital and surgeon volume, and racial differences in recurrence after surgery for prostate cancer. Methods: Data from the 1991 to 2002 Surveillance, Epidemiology, and End- Results-Medicare database were examined for 962 black and 7387) white men who received Surgery for prostate cancer within 6 months of diagnosis during 1993-1999. Cox regression models used to estimate the relationships between volume (grouped in tertiles), recurrence or death, and race. controlling for age. Gleason grade, and comorbidity score. Results: prostate cancer recurrence-free Survival rates improved with hospital and Surgical Volume. Black men were more likely to experience recurrence than white men [hazard ratio (FIR) = 1.34 959/0 confidence interval (Cl): 1.20-1.50]. Stratification by hospital Volume revealed that racial differences persisted for medium and high volume hospitals, even after covariate adjustments (medium HR = 1.30, 95% CI: 1.04-1.61; high HR = 1.36. 9-5% CI: 1.07-1.73). Racial differences persisted Within medium and high levels of Surgeon volume as well (medium HR = 1.43, 95% CI: 1.10-1.85: high HR = 1.57. 95%, CI: 1.14-2.16). Conclusions: High hospital and physician volumes were not associated with reduced racial differences in recurrence-free Survival after prostate cancer Surgery, contrary to expectation. This Study suggests that social and behavioral characteristics, and some aspects of access, may play a larger role than organizational or systemic characteristics with regard to recurrence-free survival for this population.