title: Cancer control and functional outcomes after radical prostatectomy as markers of surgical quality: analysis of heterogeneity between surgeons at a single cancer center.
abstract: BACKGROUND
  Previous studies have shown that complications and biochemical recurrence rates after radical prostatectomy (RP) vary between different surgeons to a greater extent than might be expected by chance. Data on urinary and erectile outcomes, however, are lacking.
  
  
  OBJECTIVE
  In this study, we examined whether between-surgeon variation, known as heterogeneity, exists for urinary and erectile outcomes after RP.
  
  
  METHODS
  Our study consisted of 1910 RP patients who were treated by 1 of 11 surgeons between January 1999 and July 2007.
  
  
  METHODS
  All patients underwent RP at Memorial Sloan-Kettering Cancer Center.
  
  
  METHODS
  Patients were evaluated for functional outcome 1 yr after surgery. Multivariable random effects models were used to evaluate the heterogeneity in erectile or urinary outcome between surgeons, after adjustment for case mix (age, prostate-specific antigen, pathologic stage and grade, comorbidities) and year of surgery.
  
  
  CONCLUSIONS
  We found significant heterogeneity in functional outcomes after RP (p<0.001 for both urinary and erectile function). Four surgeons had adjusted rates of full continence <75%, whereas three had rates >85%. For erectile function, two surgeons in our series had adjusted rates <20%; another two had rates >45%. We found some evidence suggesting that surgeons' erectile and urinary outcomes were correlated. Contrary to the hypothesis that surgeons "trade off" functional outcomes and cancer control, better rates of functional preservation were associated with lower biochemical recurrence rates.
  
  
  CONCLUSIONS
  A patient's likelihood of recovering erectile and urinary function may differ depending on which of two surgeons performs his RP. Functional preservation does not appear to come at the expense of cancer control; rather, both are related to surgical quality.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. vickersa@mskcc.org
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.forename: Fernando
authors.initials: F
authors.lastname: Bianco
authors.forename: John
authors.initials: J
authors.lastname: Mulhall
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Sandhu
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillonneau
authors.forename: Angel
authors.initials: A
authors.lastname: Cronin
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000453:epidemiology; D013502:General Surgery / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology