TY - JOUR
T1 - Surgeon variation in patient quality of life after radical prostatectomy
AU - Hartz, Arthur
AU - He, Tao
AU - Strope, Seth
AU - Cutler, D. Richard
AU - Andriole, Gerald
AU - Dechet, Christopher
N1 - Funding Information:
Supported by the Huntsman Cancer Foundation, Beaumont Foundation, Utah Cancer Registry funded by National Cancer Institute Contract HHSN261201000026C, Utah State Department of Health and University of Utah, and Huntsman Cancer Institute and Huntsman Cancer Center Support Grant P30 CA42014 from National Cancer Institute (Utah Population Database).
PY - 2013/4
Y1 - 2013/4
N2 - Purpose: We assessed variation among surgeons in patient quality of life outcomes. Materials and Methods: A survey of standard questions used to examine current urinary and sexual function was mailed to 1,500 randomly selected patients from the Utah Cancer Registry who met certain criteria, including prostatectomy for cancer cure more than 1 year previously, current age 70 years or less and no metastatic disease or other cancer therapy. Questionnaire information was linked to cancer registry and hospital discharge abstract information. Hierarchical mixed models were used to examine whether surgeons varied with respect to risk adjusted outcomes. Results: The cooperation rate was 64%. Of the 678 qualifying responders 22% reported leaking urine more than once per day, 7% used more than 1 pad per day and 40% reported no erection without medication. Surgeon variation was significant for 3 patient outcomes, including erectile strength, urine leakage and length of hospital stay (each p <0.001). Surgeon risk adjusted erectile outcomes significantly correlated with leakage outcomes (r = 0.84, p <0.0001) and length of stay (r = -0.55, p = 0.0004). Annual surgeon volume significantly correlated with less leakage and shorter length of stay (r = 0.34 and -0.36, respectively, each p = 0.05). Compared to open retropubic surgery, robotic surgery was associated with a shorter stay. The perineal approach was associated with shorter stay, less urine leakage and weaker erection. Conclusions: Patient quality of life outcomes after prostatectomy varies substantially among surgeons. Administering patient surveys through cancer registries may provide valuable data for improving prostatectomy outcomes statewide.
AB - Purpose: We assessed variation among surgeons in patient quality of life outcomes. Materials and Methods: A survey of standard questions used to examine current urinary and sexual function was mailed to 1,500 randomly selected patients from the Utah Cancer Registry who met certain criteria, including prostatectomy for cancer cure more than 1 year previously, current age 70 years or less and no metastatic disease or other cancer therapy. Questionnaire information was linked to cancer registry and hospital discharge abstract information. Hierarchical mixed models were used to examine whether surgeons varied with respect to risk adjusted outcomes. Results: The cooperation rate was 64%. Of the 678 qualifying responders 22% reported leaking urine more than once per day, 7% used more than 1 pad per day and 40% reported no erection without medication. Surgeon variation was significant for 3 patient outcomes, including erectile strength, urine leakage and length of hospital stay (each p <0.001). Surgeon risk adjusted erectile outcomes significantly correlated with leakage outcomes (r = 0.84, p <0.0001) and length of stay (r = -0.55, p = 0.0004). Annual surgeon volume significantly correlated with less leakage and shorter length of stay (r = 0.34 and -0.36, respectively, each p = 0.05). Compared to open retropubic surgery, robotic surgery was associated with a shorter stay. The perineal approach was associated with shorter stay, less urine leakage and weaker erection. Conclusions: Patient quality of life outcomes after prostatectomy varies substantially among surgeons. Administering patient surveys through cancer registries may provide valuable data for improving prostatectomy outcomes statewide.
KW - clinical competence
KW - penile erection
KW - penis
KW - prostatectomy
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=84875960216&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2012.10.118
DO - 10.1016/j.juro.2012.10.118
M3 - Article
C2 - 23123548
AN - SCOPUS:84875960216
SN - 0022-5347
VL - 189
SP - 1295
EP - 1301
JO - The Journal of Urology
JF - The Journal of Urology
IS - 4
ER -