Introduction: Higher surgical volume is associated with improved outcomes leading some to suggest regionalization of care and minimum surgical volume standards. Prior work from 2005 in New York state suggested that 80% of urologists performing radical prostatectomy (RP) were low annual volume surgeons who accounted for over 24% of the total RP surgical volume. We assess the extent to which current market forces have limited low-volume major surgery in New York state through a case study of the radical prostatectomy (RP) market and characterize persistent low-volume surgeons.
Methods: We used the NY Statewide Planning and Research Cooperative System (SPARCS) database to determine surgeons’ annual RP and total surgical volume from 2010 to 2015. We fit a multivariate logistic regression to determine predictors of low volume surgeons (=10 RP/year) accounting for robotic surgery, other major urologic oncology cases, career stage measured in years from medical school graduation, patient and hospital characteristics.
Results: Of 349 urologists who performed 23,568 RP for prostate cancer from 2010-2015, 78% performed a median of =10 RP/year but accounted for only 11.4% of the total RP surgical volume. Low-volume surgeons were more likely advanced career stage (16-30, and >30 years from medical school graduation), less likely to be robotic surgeons, rarely performed other major urologic oncology cases, and had low prior year volume (all p=0.001). Among low-volume surgeons 31% were over 30 years from medical school graduation. Further, 57% of low-volume RP occurred in the New York City metro area and 46% occurred at hospitals in the top quartile of RP volume.
Conclusions: While low-volume RP surgery is not set for complete extinction, its population impact is substantially reduced, now affecting roughly 11% of patients as compared to 24% in 2005. Existing market forces can promote significant consolidation for procedures such as RP and a nearly one third of remaining low-volume urologists performing RP are approaching retirement. Source of