Association Between Urologists' Caseload Volume and In-hospital Mortality for Transurethral Resection of Prostate: A Nationwide Population-based Study

Objectives: To examine the relationship between the urologist case volume for transurethral resection of the prostate (TURP) and in-hospital mortality using a Taiwan nationwide population-based data set. Methods: This study used data from the 2003 Taiwan National Health Insurance Research Database. The sample of 9539 patients who had undergone TURP was divided into three urologist caseload volume groups: fewer than 27 cases annually (low volume), 27-55 cases annually (medium volume), and more than 55 cases annually (high volume). Multivariate logistic regression analysis using generalized estimating equations was conducted to assess the adjusted association of urologist TURP caseload volume and patient in-hospital mortality to account for the urologist, patient, and hospital characteristics and the clustered nature of the study sample. Results: The in-hospital mortality rate decreased with an increasing TURP caseload volume. The in-hospital mortality rate was 2.37%, 1.97%, and 1.16% for patients treated in the low, medium, and high-volume urologist group, respectively. After adjusting for others factors, the likelihood of in-hospital mortality for patients treated by urologists with a low and medium TURP caseload volume was 1.835 (95% confidence interval 1.198-2.812, P < .01) and 1.606 (95% confidence interval 1.052-2.452, P < .05) respectively, compared with that for patients treated at high-volume hospitals. Conclusions: The results of our study have shown that, after adjusting for patient, urologist, and hospital characteristics, high-volume urologists are associated with superior treatment outcomes for patients undergoing TURP.