Surgical quality is more than volume: the association between changing urologists and complications for patients with localized prostate cancer.
OBJECTIVE
To examine the association of changing urologists on surgical complications in men with prostate cancer.


METHODS
Registry and administrative claims data from the Surveillance, Epidemiology, and End Results-Medicare database from 1995 to 2005.


METHODS
A cross-sectional observational study of men with prostate cancer who underwent radical prostatectomy.


METHODS
Subjects were classified as having "changed urologists" if they had a different urologist who diagnosed their cancer from the one who performed their surgery. "Doubly robust" propensity score weighted multivariable logistic regression models were used to investigate the effect of changing urologists on 30-day surgical complications, late urinary complications, and long-term incontinence.


RESULTS
Men who changed urologists between diagnosis and treatment had significantly lower odds of 30-day surgical complications compared with men who did not change urologists (odds ratio: 0.82; 95 percent confidence interval: 0.76-0.89), after adjustment. Changing urologists was associated with lower risks of 30-day complications for both black and white men compared with staying with the same urologist for their diagnosis and surgical treatment.


CONCLUSIONS
Urologist changing is associated with the observed variation in complications following radical prostatectomy. This may suggest that patients are responding to aspects of surgical quality not captured in surgical volume.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Eva H
EH
DuGoff
Justin E
JE
Bekelman
Elizabeth A
EA
Stuart
Katrina
K
Armstrong
Craig Evan
CE
Pollack
D000368:Aged; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D057240:Patient Preference; D010817:Physician-Patient Relations; D011183:Postoperative Complications; D057216:Propensity Score; D011468:Prostatectomy / Q000009:adverse effects / Q000592:standards*; D011787:Quality of Health Care; D012042:Registries; D018426:SEER Program; D014572:Urology
Quality of care; cancer care; physician switching