Tumore maligno alla prostata: volume annuale di interventi chirurgici


Indice

Descrizione indicatore

L’indicatore ci consente di calcolare il numero di interventi chirurgici per tumori maligni della prostata eseguiti in un anno in una struttura ospedaliera (indicatore di "volume").

Come si legge

L’indicatore si riferisce al grado di "competenza" e di "sicurezza" delle cure prestate. 
Più alto è il numero di interventi chirurgici per tumori maligni della prostata eseguiti in una struttura ospedaliera, maggiore è il grado di esperienza della struttura stessa e la sicurezza del trattamento offerto.

Descrizione generale

Il tumore della prostata ha origine dalle cellule presenti all’interno della ghiandola che cominciano a crescere senza controllo (adenocarcinoma). 
È uno dei tumori più frequenti negli anziani e in Italia ci sono circa 23.000 nuovi casi ogni anno. 
Per questo tipo di tumore i fattori di rischio più rilevanti sono la razza, con i neri maggiormente interessati rispetto ai bianchi, e la familiarità per la patologia. 
Alla presenza di tumore della prostata il paziente è sottoposto ad asportazione dell’organo o a radioterapia o terapia endocrina. La scelta è legata, da un lato alla valutazione del tipo, del grado e dello stadio del tumore e, dall’altro, all’età e alle condizioni del paziente. 

Valutazione istituzionale

Il Gruppo di lavoro del Programma Nazionale Esiti ha identificato la seguente soglia minima di volume di attività: 50 procedure/anno.

Codici ICD-9-CM selezionati

Sono inclusi tutti i ricoveri, in regime ordinario, con diagnosi principale o secondaria di tumore maligno della prostata (ICD-9-CM 185, 198.82) ed intervento principale o secondario di resezione o asportazione radicale della prostata (ICD-9-CM 60.3, 60.4, 60.5, 60.61, 60.62, 60.69) o intervento di resezione trans-uretrale della prostata (ID-9-CM 60.21, 60.29, 60.96, 60.97).

Il volume di ricoveri per interventi chirurgici è calcolato su base annuale, riferito all’anno di dimissione del ricovero.

Consulta le strutture sanitarie che effettuano in un anno il maggior numero di interventi chirurgici per tumori maligni della prostata

​​​Fonte del dato

Programma Nazionale Esiti 2018, indicatore 109. 
Confronto tra strutture calcolato su dati 2017.

Nota bene: per tener conto di errori di attribuzione, sono escluse dall'analisi le strutture con volumi di attività molto bassi (min 5/anno). Come riportato nel documento elaborato dal PNE, la definizione dell’esposizione sulla base dei volumi della struttura piuttosto che dell’unità operativa potrebbe essere soggetta a misclassificazione.

Fonte della Valutazione Istituzionale

Il semaforo è calcolato sulla base del seguente documento ufficiale:

Altre fonti scientifiche

  • Trinh QD, Bjartell A, Freedland SJ et al. A systematic review of the volume-outcome relationship for radical prostatectomy. Eur Urol 2013;64(5):786-98. doi: 10.1016/j.eururo.2013.04.012.
  • Wilson A, Marlow NE, Maddern GJ et al. Radical prostatectomy: a systematic review of the impact of hospital and surgeon volume on patient outcome. ANZ J Surg 2010;80(1-2):24-9.
  • Barocas DA, Mitchell R, Chang SS, Cookson MS. Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol 2010;28(3):243-50.
  • Mayer EK, Purkayastha S, Athanasiou T, Darzi A, Vale JA. Assessing the quality of the volume-outcome relationship in uro-oncology. BJU Int 2009;103(3):341-49.
  • Wilt TJ, Shamliyan TA, Taylor BC, MacDonald R, Kane RL. Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review. J Urol 2008;180(3):820-8; discussion 828-9.
  • Killeen SD, O'Sullivan MJ, Coffey JC, Kirwan WO, Redmond HP. Provider volume and outcomes for oncological procedures. Br J Surg 2005;92(4):389-402.
  • Nuttall M, van der Meulen J, Phillips N et al. A systematic review and critique of the literature relating hospital or surgeon volume to health outcomes for 3 urological cancer procedures. J Urol 2004;172(6 Pt 1):2145-52.
  • Gandjour A, Bannerberg A, Lauterbach KW. Threshold volumes associated with higher survival in health care. Med Care 2003;41(10):1129-41.
  • Pla R, Pons JMV, Gonzalez JR, Borras JM. Hay niveles assistenciales en cirurgia oncologica? Los que mas hacen, lo hacen mejor? In-forme sobre la relacion entre volumen de procedimientos y resultados en cirurgia oncologica. Barcelona, Agència d'Avaluaciò de Tecnologia i Recerca Mèdiques, CatSalut, Department de Sanitat i Seguretat Social, Generalitat de Catalunya, 2003, pp. 1-59.
  • Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002:137(6):511-20.
  • Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000;283(9):1159-66.
  • Alibhai SM, Leach M, Tomlinson G. Impact of hospital and surgeon volume on mortality and complications after prostatectomy. J Urol 2008;180(1):155-62; discussion 162-63.
  • Begg CB, Riedel ER, Bach PB et al. Variations in morbidity after radical prostatectomy. N Engl J Med 2002;346(15):1138-44.
  • Bianco FJ Jr, Riedel ER, Begg CB, Kattan MW, Scardino PT. Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol 2005;173(6):2099-103.
  • Briganti A, Capitanio U, Chun FK et al. Impact of surgical volume on the rate of lymph node metastases in patients undergoing radical prostatectomy and ex- tended pelvic lymph node dissection for clinically localized prostate cancer. Eur Urol 2008;54(4):794-802.
  • Budäus L, Morgan M, Abdollah F et al. Impact of annual surgical volume on length of stay in patients undergoing minimally invasive prostatectomy: a population-based study. Eur J Surg Oncol 2011;37(5):429-34.
  • Budäus L, Sun M, Abdollah F et al. Impact of surgical experience on in-hospital complication rates in patients undergoing minimally invasive prostatectomy: a population-based study. Ann Surg Oncol 2010a;18(3):839-47.
  • Budäus L, Abdollah F, Sun M et al. The impact of surgical experience on total hospital charges for minimally invasive prostatectomy: a population-based study. BJU Int 2010b;108(6):888-93.
  • Choi WW, Gu X, Lipsitz SR, D’Amico AV, Williams SB, Hu JC. The effect of minimally invasive and open radical prostatectomy surgeon volume. Urol Oncol 2012; 30(5):569-76.
  • Chun FK, Briganti A, Antebi E et al. Surgical volume is related to the rate of positive surgical margins at radical prostatectomy in European patients. BJU Int 2006;98(6):1204-09.
  • Dash A, Dunn RL, Resh J, Wei JT, Montie JE, Sanda MG. Patient, surgeon, and treatment characteristics associated with homologous blood transfusion requirement during radical retropubic prostatectomy: multivariate nomogram to assist patient counseling. Urology 2004;64(1):117-22.
  • Eastham JA, Kattan MW, Riedel E et al. Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol 2003;170(6 Pt 1):2292-95.
  • Ellison LM, Heaney JA, Birkmeyer JD. The effect of hospital volume on mortality and resource use after radical prostatectomy. J Urol 2000;163(3):867-69. Ellison LM, Trock BJ, Poe NR, Partin AW. The effect of hospital volume on cancer control after radical prostatectomy. J Urol 2005;173(6):2094-98.
  • Gaylis FD, FriedelWE, Armas OA. Radical retropubic prostatectomy outcomes at a community hospital. J Urol 1998;159(1):167-71.
  • Gheiler EL, Lovisolo JA, Tiguert R et al. Results of a clinical care pathway for radical prostatectomy patients in an open hospital - multiphysician system. Eur Urol 1999;35(3):210-16.
  • Gooden KM, Howard DL, Carpenter WR et al. The effect of hospital and surgeon volume on racial differences in recurrence-free survival after radical prostatectomy. Med Care 2008;46(11):1170-76.
  • Hanchanale VS, Javié P. Impact of hospital provider volume on outcome for radical urological cancer surgery in England. Urol Int 2010;85(1):11-15. Hanchanale VS, McCabe JE, Javié P. Radical prostatectomy practice in England. Urol J 2010;7(4):243-48.
  • Hernandez DJ, Epstein JI, Trock BJ, Tsuzuki T, Carter HB,Walsh PC. Radical retro-pubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle? J Urol 2005;173(2):446-49.
  • Hollenbeck BK, Dunn RL, Miller DC, Daignault S, Taub DA,Wei JT. Volume-based referral for cancer surgery: informing the debate. J Clin Oncol 2007;25(1):91-6. Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 2003;21(3):401-05.
  • Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL. Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol 2008;26(14):2278-84. Hughes RG, Hunt SS, Luft HS. Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care 1987;25(6):489-503.
  • Judge A, Evans S, Gunnell DJ, Albertsen PC, Verne J, Martin R. Patient outcomes and length of hospital stay after radical prostatectomy for prostate cancer: analysis of hospital episodes statistics for England. BJU Int 2007;100(5):1040-49. 
  • Karakiewicz PI, Bazinet M, Aprikian AG, Tanguay S, Elhilali MM. Thirty-day mortality rates and cumulative survival after radical retropubic prostatectomy. Urology 1998;52(6):1041-46.
  • Kattan MW, Vickers AJ, Yu C et al. Preoperative and postoperative nomograms incorporating surgeon experience for clinically localized prostate cancer. Cancer 2009;115(5):1005-10.
  • Klein EA, Bianco FJ, Serio AM et al. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol 2008;179(6):2212-26; discussion 2216-17.
  • Konety BR, Allareddy V, Modak S, Smith B. Mortality after major surgery for urologic cancers in specialized urology hospitals: are they any better? J Clin Oncol 2006;24(13):2006-12.
  • Ku TS, Kane CJ, Sen S, Henderson WG, Dudley RA, Cason BA. Effects of hospital procedure volume and resident training on clinical outcomes and resource use in radical retropubic prostatectomy surgery in the Department of Veterans Affairs. J Urol 2008;179(1):272-78; discussion 278-79.
  • Leibman BD, Dillioglugil O, Abbas F, Tanli S, Kattan MW, Scardino PT. Impact of a clinical pathway for radical retropubic prostatectomy. Urology 1998;52(1):94-99. 
  • Litwiller SE, Djavan B, Klopukh BV, Richier JC, Roehrborn CG. Radical retropubic prostatectomy for localized carcinoma of the prostate in a large metropolitan hospital: changing trends over a 10-year period (1984-1994). Dallas Outcomes Research Group for Urological Disorders. Urology 1995;45(5):813-22.
  • Lowrance WT, Elkin EB, Jacks LM et al. Comparative effectiveness of prostate cancer surgical treatments: a population based analysis of postoperative outcomes. J Urol 2010;183(4):1366-72.
  • Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: practice-makes- perfect or selective-referral patterns? Health Serv Res 1987;22(2):157-82. 
  • Mitchell RE, Lee BT, Cookson MS et al. Immediate surgical outcomes for radical prostatectomy in the University Health System Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48,000 patients. BJU Int 2009;104(10):1442-45.
  • Riley G, Lubitz J. Outcomes of surgery among the Medicare aged: surgical volume and mortality. Health Care Financ Rev 1985;7(1):37-47.
  • Secin FP, Savage C, Abbou C et al. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol 2010;184(6):2291-96.
Installa subito l'APP
e resta sempre aggiornato!