title: Quantifying severe urinary complications after radical prostatectomy: the development and validation of a surgical performance indicator using hospital administrative data.
abstract: To develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data.
  
  
  
  Men who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into 'stricture', 'incontinence' and 'other'. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics.
  
  
  
  A total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26-1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40-1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58-0.74).
  
  
  
  These results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers.
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
authors.forename: Arunan
authors.initials: A
authors.lastname: Sujenthiran
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Charman
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Parry
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Nossiter
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: MRC Centre for Transplantation, King's College London, London, UK.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Department of Oncology, University College London Hospitals, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Payne
authors.affiliation: Department of Urology, Christie and Salford Royal NHS Foundation Trusts, Manchester, UK.
authors.forename: Noel W
authors.initials: NW
authors.lastname: Clarke
authors.affiliation: Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cathcart
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
mesh_terms: D000368:Aged; D059019:Clinical Coding; D002983:Clinical Competence; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology; D016208:Databases, Factual; D004739:England; D006801:Humans; D007902:Length of Stay; D008297:Male; D008500:Medical Records Department, Hospital / Q000458:organization & administration; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology; D014555:Urination Disorders / Q000175:diagnosis* / Q000209:etiology
keywords: performance indicator; radical prostatectomy; urinary complications