Annual radical prostatectomy (RP) caseloads are low for the majority of U.S. surgeons, and this may translate into suboptimal patient outcomes, according to researchers.

Approximately 80% of surgeons in the United States perform fewer than 10 RPs per year and are thus “unlikely to reach the plateau of the learning curve during their surgical career,” they concluded.

To reach that plateau, surgeons need to perform at least 250 radical prostatectomies, according to a previous study cited by the investigators. This is the volume necessary for a surgeon to maximize cancer control, according to the researchers.

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Caroline J. Savage, MPH, and Andrew J. Vickers, PhD, examined radical prostatectomy caseloads of U.S. surgeons using two independent data sets for 2005: a nationally representative sample (the Independent Inpatient Sample) and a complete record of all hospital discharges from New York State (the Statewide Planning and Research Cooperative System).

Of the surgeons who performed radical prostatectomies in 2005, 27% performed only a single procedure, the authors reported in the Journal of Urology (2009; published online ahead of print). Only 1.8% performed 50 or more of these procedures.

“The majority of surgeons performing radical prostatectomy in the United States have extremely low annual caseloads,” the investigators wrote. “Given that caseload and overall experience are associated with improved outcomes, this scenario is likely to lead to suboptimal outcomes.”

The authors acknowledged that using 250 prior radical prostatectomies as a criterion for reaching the plateau of the learning curve is a somewhat arbitrary threshold that is open to discussion. “However,” they noted, “the majority of surgeons have such low annual volumes that our conclusions would not change even if we halved the minimum number of surgeries considered to be adequate.”