Adoption of New Technology and Healthcare Quality: Surgical Margins After Robotic Prostatectomy

Alon Z. Weizer, Zaojun Ye, John M. Hollingsworth, Rodney L. Dunn, Rajal B. Shah, J. Stuart Wolf, John T. Wei, James E. Montie, Brent K. Hollenbeck

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: To study the evolution of surgical margins in robotic prostatectomy (DVP), to ascertain the surgical volume necessary to provide quality cancer care. Methods: Clinicopathologic data on consecutive DVP patients were abstracted from our institutional database. The primary outcome evaluated was the presence of any positive surgical margin. Surgeon DVP volume was the unit of exposure. A logistic model was fit to measure the association of volume and margin status, adjusting for patient differences. Results: Between November 2001 and August 2005, 193 consecutive patients underwent DVP. Disease and patient characteristics were similar across the levels of surgeon volume. Overall, surgical margins did not dramatically decline over time (first 15 cases, 26% versus cases 81 and beyond, 22%; P = 0.82). However, extensive margins were largely eliminated (first 15 cases, 12% versus cases 81 and beyond, 2%; P = 0.05). After adjusting for preoperative patient differences, the odds of any positive margin among those treated by a surgeon in the highest-volume group was 0.99 (95% confidence interval 0.36 to 2.72) compared with those treated during a surgeon's first 15 cases. Conclusions: Although extensive surgical margins decline with increasing volume, overall positive margin rates after DVP respond slowly. It seems that cumulative surgeon volume beyond that which can be obtained in the typical urology practice may be needed to obtain ideal margin rates with this new technology.

Original languageEnglish (US)
Pages (from-to)96-100
Number of pages5
JournalUrology
Volume70
Issue number1
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

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Quality of Health Care
Robotics
Prostatectomy
Technology
Urology
Logistic Models
Margins of Excision
Surgeons
Databases
Confidence Intervals
Neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Weizer, A. Z., Ye, Z., Hollingsworth, J. M., Dunn, R. L., Shah, R. B., Wolf, J. S., ... Hollenbeck, B. K. (2007). Adoption of New Technology and Healthcare Quality: Surgical Margins After Robotic Prostatectomy. Urology, 70(1), 96-100. https://doi.org/10.1016/j.urology.2007.03.004

Adoption of New Technology and Healthcare Quality : Surgical Margins After Robotic Prostatectomy. / Weizer, Alon Z.; Ye, Zaojun; Hollingsworth, John M.; Dunn, Rodney L.; Shah, Rajal B.; Wolf, J. Stuart; Wei, John T.; Montie, James E.; Hollenbeck, Brent K.

In: Urology, Vol. 70, No. 1, 01.07.2007, p. 96-100.

Research output: Contribution to journalArticle

Weizer, AZ, Ye, Z, Hollingsworth, JM, Dunn, RL, Shah, RB, Wolf, JS, Wei, JT, Montie, JE & Hollenbeck, BK 2007, 'Adoption of New Technology and Healthcare Quality: Surgical Margins After Robotic Prostatectomy', Urology, vol. 70, no. 1, pp. 96-100. https://doi.org/10.1016/j.urology.2007.03.004
Weizer, Alon Z. ; Ye, Zaojun ; Hollingsworth, John M. ; Dunn, Rodney L. ; Shah, Rajal B. ; Wolf, J. Stuart ; Wei, John T. ; Montie, James E. ; Hollenbeck, Brent K. / Adoption of New Technology and Healthcare Quality : Surgical Margins After Robotic Prostatectomy. In: Urology. 2007 ; Vol. 70, No. 1. pp. 96-100.
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