Surgeon-specific Variations Affect Urinary Outcomes Following Prostatectomy

A study examined how patient- and surgeon-specific variations may be predictive of patient-reported urinary outcomes after prostatectomy. The authors reported substantial surgeon-specific variations, which they noted may have an impact on patient morbidity.

A total of 4,582 men who underwent radial prostatectomy between April 2014 and July 2018 were identified from the Michigan Urological Surgery Improvement Collaborative. Participants agreed to fill out validated questionnaires preoperatively and three, six, and 12 months postoperatively. The main outcomes were patient- and surgeon-level evaluations of patient-reported urinary function three months postoperatively, which were determined per the questionnaires on a 100-point scale, with a score ≥74 indicating good urinary function.

The mean age of the men who agreed to fill out a survey was 63.3 years (standard deviation [SD], 7.1 years). Survey response rates changed at different time points but remained above three-quarters at baseline (83%), three months (79%), six months (79%), and 12 months (77%). Over the study period, the mean (SD) urinary function scores were: baseline, 88.5 (14.3); three months, 53.6 (27.5); six months. 68 (25.1); and 12 months, 73.7 (23). In regression analysis, factors associated with a lower likelihood of self-reported good urinary function three months postoperatively were older age, lower urinary function score at baseline, body mass index ≥30 kg/m2, clinical stage T2 or higher, and lack of bilateral nerve-sparing surgery.

Significant variations were observed in the rate of surgeons’ patients reporting good urinary function at three months among patients with good baseline function, ranging from 0% to 54.5% (P<0.001). Even when risk factors were taken into consideration, a correlation was observed between undergoing surgery with a top-performing surgeon and good three-month urinary function.

The study was published in JAMA Surgery.

“In this study, patient- and surgeon-level urinary outcomes following prostatectomy varied substantially. Documenting surgeon-specific variations after accounting for patient factors may facilitate identification of surgical factors associated with superior outcomes,” the study authors wrote in their conclusion.