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Open Access Research article

Effects of surgeon variability on oncologic and functional outcomes in a population-based setting

Sigrid Carlsson12*, Anders Berglund3, Daniel Sjoberg4, Ali Khatami2, Johan Stranne2, Svante Bergdahl2, Pär Lodding2, Gunnar Aus5, Andrew Vickers4 and Jonas Hugosson2

Author Affiliations

1 Urology Service at the Department of Surgery, Memorial Sloan-Kettering Cancer Center, 307 E. 63rd St, 2nd floor, New York, NY 10065, USA

2 Department of Urology, Sahlgrenska Academy at the University of Göteborg, Göteborg, Sweden

3 Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden

4 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA

5 Department of Urology, Carlanderska hospital, Göteborg, Sweden

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BMC Urology 2014, 14:25  doi:10.1186/1471-2490-14-25

Published: 6 March 2014

Abstract

Background

Oncologic and functional outcomes after radical prostatectomy (RP) can vary between surgeons to a greater extent than is expected by chance. We sought to examine the effects of surgeon variation on functional and oncologic outcomes for patients undergoing RP for prostate cancer in a European center.

Methods

The study comprised 1,280 men who underwent open retropubic RP performed by one of nine surgeons at an academic institution in Sweden between 2001 and 2008. Potency and continence outcomes were measured preoperatively and 18 months postoperatively by patient-administered questionnaires. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value > 0.2 ng/mL with at least one confirmatory rise. Multivariable random effect models were used to evaluate heterogeneity between surgeons, adjusting for case mix (age, PSA, pathological stage and grade), year of surgery, and surgical experience.

Results

Of 679 men potent at baseline, 647 provided data at 18 months with 122 (19%) reporting potency. We found no evidence for heterogeneity of potency outcomes between surgeons (P = 1). The continence rate for patients at 18 months was 85%, with 836 of the 979 patients who provided data reporting continence. There was statistically significant heterogeneity between surgeons (P = 0.001). We did not find evidence of an association between surgeons’ adjusted probabilities of functional recovery and 5-year probability of freedom from BCR.

Conclusions

Our data support previous studies regarding a large heterogeneity among surgeons in continence outcomes for patients undergoing RP. This indicates that some patients are receiving sub-optimal care. Quality assurance measures involving performance feedback, should be considered. When surgeons are aware of their outcomes, they can improve them to provide better care to patients.

Keywords:
Prostate cancer; Radical prostatectomy; Erectile function; Urinary function