A data-driven study demonstrating that men undergoing robot-assisted prostate surgery for cancer are more likely to have better outcomes at centres which perform the operation most often has been published in an international medical journal.
The observational study of volume-outcome effects for robot-assisted radical prostatectomy (RARP) in England is authored by a team from the GIRFT programme, and appears in the British Journal of Urology International (BJUI).
The study analysed hospital data from more than 35,000 radical prostatectomy procedures carried out between 2013 and 2018. The use of robot-assisted surgery increased significantly over that period, from 53% of procedures in 2013 to 93% in 2018. As a result, almost 28,000 of the operations analysed were robot-assisted.
The study found that 10.6% of patients were readmitted to hospital as an emergency within 30 days of RARP procedures carried out in low-volume trusts (0-49 procedures per year), while just 7% were readmitted after operations at high-volume centres (300 RARP operations or more). Similarly, 9.4% of patients were readmitted within 30 days of RARP procedures carried out by low-volume surgeons (0-9 procedures per year) while 8.3% were readmitted after operations with high-volume surgeons (100 or more).
The authors conclude that minimising low-volume RARP will improve patient outcomes. This supports the findings of the 2018 GIRFT national report for urology, which recommended that the number of complex surgical procedures carried out in small volume centres should be reduced, and which pledged to support further research to investigate the volume-outcome relationship in urology.
The new BJUI study is one of just a handful examining volume-outcome effects for radical prostatectomy in the UK, with the majority of previous research carried out in Germany and the USA.
The GIRFT authors are:
- William K Gray: senior research associate
- Jamie Day: retired chief information officer
- Tim Briggs: Chair of GIRFT and National Director of Clinical Improvement for the NHS
- Simon Harrison: clinical lead for urology and author of the 2018 national report.
