title: Surgeon variation in patient quality of life after radical prostatectomy.
abstract: OBJECTIVE
  We assessed variation among surgeons in patient quality of life outcomes.
  
  
  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.
authors.affiliation: Health Services Research, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA. hartzarthur@gmail.com
authors.forename: Arthur
authors.initials: A
authors.lastname: Hartz
authors.forename: Tao
authors.initials: T
authors.lastname: He
authors.forename: Seth
authors.initials: S
authors.lastname: Strope
authors.forename: D Richard
authors.initials: DR
authors.lastname: Cutler
authors.forename: Gerald
authors.initials: G
authors.lastname: Andriole
authors.forename: Christopher
authors.initials: C
authors.lastname: Dechet
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology