title: Notable Outcomes and Trackable Events after Surgery: Evaluating an Uncomplicated Recovery after Radical Prostatectomy.
abstract: A priority of MUSIC (Michigan Urological Surgery Improvement Collaborative) is to improve patient outcomes after radical prostatectomy. As part of these efforts we developed a novel system that uses unambiguous events to define an uncomplicated 30-day postoperative recovery and compares these outcomes across diverse urology practices.
  
  
  
  MUSIC used a consensus approach to develop an uncomplicated recovery pathway comprising a set of precise perioperative events that are reliably measured and collectively reflect resource utilization, technical complications and coordination of care. Events that occurred outside the uncomplicated recovery pathway were considered deviations, including rectal injury, high blood loss, extended length of stay, prolonged drain or catheter placement, catheter replacement, hospital readmission or mortality. For men undergoing radical prostatectomy trained abstractors prospectively recorded clinical and perioperative data in an electronic registry. When a deviation from the NOTES (Notable Outcomes and Trackable Events after Surgery) pathway occurred, precipitating events were described by abstractors and we analyzed the events.
  
  
  
  From April 2014 through July 2015 a total of 2,245 radical prostatectomies were performed by 100 surgeons in a total of 37 diverse participating MUSIC practices. In the 29 practices in which 10 or more radical prostatectomies were performed during the interval analyzed the risk adjusted deviation rate ranged from 0.0% to 46.1% (p <0.0001). Anastomotic and gastrointestinal events were contributing factors in 50.2% of deviated cases.
  
  
  
  The novel NOTES system provides comparative data on unambiguous and actionable short-term outcomes after radical prostatectomy. The observed variation in outcomes across practices suggests opportunities for quality improvement initiatives. Decreasing anastomotic and gastrointestinal events represents a high impact opportunity for initial quality improvement efforts.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Stacie N
authors.initials: SN
authors.lastname: Myers
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.affiliation: Spectrum Health Medical Group, Grand Rapids, Michigan.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.affiliation: Michigan Institute of Urology, Detroit, Michigan.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Schervish
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Linsell
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: jmdupree@umich.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Dupree
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D016896:Treatment Outcome
keywords: data collection; outcome assessment (health care); prostate; prostatectomy; quality improvement