Clinical Edge

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Hospital Competition & Prostate Cancer Outcomes

Cancer; ePub 2019 Feb 1; Aggarwal, et al

Hospital competition may improve short-term outcomes after prostate cancer surgery, a new study found. A national population-based study examined the impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery. The analyses included all men who underwent prostate cancer surgery in the UK between 2008 and 2011 (n=12,925). Multilevel logistic regression was used to assess the effect of a radical prostatectomy center being located in a competitive environment and being a successful competitor on 3 patient-level outcomes: 1) postoperative length of hospital stay >3 days; 2) 3-day emergency readmissions; and 3) 2-year urinary complications. Researchers found:

  • With adjustment for patient characteristics, men who underwent surgery in centers located in a stronger competitive environment were less likely to have a 30-day emergency readmission, irrespective of the type of volume of procedures performed at each center.
  • Men who received treatment at centers that were successful competitors were less likely to have a length of hospital stay >3 days.


Aggarwal AK, Sujenthiran A, Lewis D, et al. Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population-based study. [Published online ahead of print February 1, 2019]. Cancer. doi:10.1002/cncr.31987.


Aggarwal et al. evaluated a unique hypothesis that not just volume, but presence in a competitive environment, and success at attracting patients in that environment, may be associated with improved outcomes. They identified an association between lower length of hospital stay in patients who underwent prostatectomy amongst hospitals that were considered more competitive. The findings raise points of discussion about markers and determinants of quality. The study was performed in the United Kingdom, where their National Health Service has significant differences from the fee-for-service model prevalent in the US but could have some relevance to other, more closed, systems. —Mark A. Klein, MD