Impact of annual surgical volume on length of stay in patients undergoing minimally invasive prostatectomy: A population-based study

Background: On average, patients remain hospitalized no more than 2 days after MIRP. The aim of our study was to examine the temporal trends in length of stay ≥3 days and to test the relationship between annual surgical volume (ASV) and annual hospital volume (AHV) and length of stay ≥3 days in patients undergoing MIRP. Material and methods: Within the Florida Hospital Inpatient Datafile, 2439 men who were treated with MIRP for prostate cancer between 2005 and 2008 were identified. Temporal trends were assessed and uni and multi-variable logistic regression models tested the relationship between ASV, AHV and length of stay ≥3 days. Results: The average length of stay decreased from 2.4 in 2005 to 1.7 days in 2008. Length of stay ≥3 days was recorded in 13.6% of patients and the proportion of patients staying more than ≥3 days decreased over time (25.5-12.2%; Chi Square trend p < 0.001). After stratification into low (<1-15 MIRPs) vs. intermediate (16-63 MIRPs) vs. high ASV tertiles (≥64 MIRPs) the proportion of patients with length of stay ≥3 days were 29.1; 13.2 and 11.1%. In multivariable logistic regression models predicting length of stay ≥3 days, ASV, year of surgery and comorbidities achieved independent predictor status and MIRP patients operated by highest ASV tertile surgeons were 71% (p < 0.001) less likely to be hospitalized for more than 3 days. Conclusion: The length of stay after MIRP decreased between 2005 and 2008. Surgical expertise represented one of the main determinants of shorter length of stay.