Hospital Volume as a Determinant of Outcomes After Partial Nephrectomy: A Systematic Review by the European Association of Urology Renal Cell Carcinoma Guidelines Panel.

Abstract

The influence of surgical volume on partial nephrectomy (PN) outcomes is a subject of debate. The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel performed a protocol-driven systematic review of the association between hospital volume (HV) and oncological, functional, and complication outcomes following PN for RCC. The intervention was PN performed in a higher-volume hospital (defined according to the number of procedures per unit time) and the comparator was PN performed in a lower-volume hospital. Ten studies involving a total of 106 569 patients were included in the review. Higher HV was associated with lower complication rates, shorter length of stay, lower positive surgical margin rates, and lower transfusion rates. For six studies, multivariable analyses showed that low HV was an independent risk factor for inpatient complications, PSM presence, longer LOS, and failure to achieve a trifecta of no complications, warm ischemia time <25 min, and negative surgical margins. Most studies were judged to have high risk of bias. The available evidence suggests a potential association between higher HV and better PN outcomes in RCC. The EAU RCC guidelines panel encourages the development and rigorous evaluation of indicators of surgery quality in RCC to better inform the designation of high-quality centers within models of centralized care.