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

Julie Nossiter*, Melanie Morris, Thomas E. Cowling, Matthew G. Parry, Arunan Sujenthiran, Ajay Aggarwal, Heather Payne, Jan van der Meulen, Noel W. Clarke, Paul Cathcart

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

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.

Original languageEnglish
JournalPROSTATE CANCER AND PROSTATIC DISEASES
DOIs
Publication statusAccepted/In press - 2021

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