Prostate surgery risks lower at academic hospitals
NEW YORK (Reuters Health) - A man's risk of complications from prostate cancer surgery may be slightly lower if it's done at a hospital connected to a medical school, a new study suggests.
Looking at nearly 90,000 prostate cancer surgeries done at U.S. hospitals, researchers found that men who had their surgery at an academic medical center were less likely to need a blood transfusion or to have a post-surgery complication while still in the hospital.
Overall, just over five percent needed a transfusion, compared with just over seven percent of men who had surgery at a non-academic hospital.
The difference in post-surgery complications was similar: 10 percent, versus 13 percent. Complications ranged from fairly minor ones, like urinary tract infections and infections around the surgical incision, to serious ones like heart attack.
At academic hospitals, 1.2 percent of men had some type of heart complication, compared with 1.5 percent at non-academic centers.
There's no single definition of an academic medical center, but it usually means the hospital is affiliated with a university.
It's not clear from the study why academic centers had somewhat lower complication rates. But it might be related to "processes of care," the researchers say.
That is, academic centers might be better at things like pre-surgery evaluation, which includes spotting patients at particular risk for complications and, if possible, minimizing the risk.
Still, the findings do not mean that academic hospitals always offer better care than your local community hospital, said lead researcher Dr. Quoc-Dien Trinh, a urologist at the Henry Ford Health System in Detroit.
"I think the key is that we're talking about averages," he told Reuters Health.
"Some non-academic hospitals might offer superior care, and some academic hospitals might provide less-than-optimal care," Trinh said.
However, he added, men should be aware of the higher relative risk of complications at non-academic centers.
The study, published in the Journal of Urology, used information from a national database that covers about 20 percent of U.S. hospitals. It included discharge records for 89,965 men who had a radical prostatectomy (removal of the prostate) sometime between 2001 and 2007.
More than half of those surgeries -- 58 percent -- were done at an academic hospital.
Trinh's team was able to account for a number of other factors that could affect a man's risk of complications from prostate removal. Those include overall health, age, and the number of radical prostatectomies the hospital does in a year.
Even then, the researchers found, academic centers still appeared slightly better: Men were seven percent less likely to have a post-surgical complication, and nine percent less likely to have an extended hospital stay (beyond three days).
One thing the study could not factor in was individual surgeons' experience. Several studies have found that the number of prostatectomies your surgeon has done is a key factor in the outcome.
That's something men can ask their surgeons about, according to Trinh. But there's no good way to find out how well your hospital and surgeon perform, he noted.
"Unfortunately, it is extremely hard to compare outcomes between surgeons and institutions, since the way outcomes are captured and reported varies greatly from one institution to another," Trinh said.
Because prostate cancer is often slow-growing and may never threaten a man's life, many men with early-stage tumors can decide between immediate surgery or "active surveillance" -- where the cancer is monitored closely over time to see if it's progressing.
The risk of surgery complications is one of the factors a man would want to consider in weighing his treatment options, Trinh said.
He also noted, though, that active surveillance can have its downsides, including anxiety and the need for repeat biopsies -- which themselves can have side effects, including infections and temporary urinary problems.
SOURCE: Journal of Urology, November 2011.
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