Association of surgeon and hospital volume with short-term outcomes after robotassisted radical prostatectomy: Nationwide, population-based study

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Background and objective Few studies have investigated the association between surgical volume and outcome of robot-assisted radical prostatectomy (RARP) in an unselected cohort. We sought to investigate the association between surgical volume with peri-operative and short-term outcomes in a nation-wide, population-based study group. Methods 9,810 RARP's registered in the National Prostate Cancer Register of Sweden (2015-2018) were included. Associations between outcome and volume were analyzed with multivariable logistic regression including age, PSA-density, number of positive biopsy cores, cT stage, Gleason score, and extent of lymph node dissection. Results Surgeons and hospitals in the highest volume group compared to lowest group had shorter operative time; surgeon (OR 9.20, 95% CI 7.11-11.91), hospital (OR 2.16, 95% CI 1.53- 3.06), less blood loss; surgeon (OR 2.58. 95% CI 2.07-3.21) hospital (no difference), more often nerve sparing intention; surgeon (OR 2.89, 95% CI 2.34-3.57), hospital (OR 2.02, 95% CI 1.66-2.44), negative margins; surgeon (OR 1.90, 95% CI 1.54-2.35), hospital (OR 1.28, 95% CI 1.07-1.53). There was wide range in outcome between hospitals and surgeons with similar volume that remained after adjustment. Conclusions High surgeon and hospital volume were associated with better outcomes. The range in outcome was wide in all volume groups, which indicates that factors besides volume are of importance. Registration of surgical performance is essential for quality control and improvement.


  • Rebecka Arnsrud Godtman
  • Erik Persson
  • Walter Cazzaniga
  • Fredrik Sandin
  • Stefan Carlsson
  • Göran Ahlgren
  • Eva Johansson
  • David Robinsson
  • Jonas Hugosson
  • Pär Stattin
External organisations
  • Sahlgrenska University Hospital
  • San Raffaele Hospital
  • Uppsala University
  • Karolinska University Hospital
  • Karolinska Institutet
  • Skåne University Hospital
  • Högland hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery
Original languageEnglish
Article numbere0253081
JournalPLoS ONE
Issue number6 June 2021
Publication statusPublished - 2021
Publication categoryResearch