Assessing the Quality of Surgical Care for Clinically Localized Prostate Cancer: Results from the CEASAR Study.
Publication/Presentation Date
12-1-2020
Abstract
PURPOSE: Prior studies suggest that nationally endorsed quality measures for prostate cancer care are not linked closely with outcomes. Using a prospective, population based cohort we measured clinically relevant variation in structure, process and outcome measures in men undergoing radical prostatectomy.
MATERIALS AND METHODS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) Study enrolled men with clinically localized prostate cancer diagnosed from 2011 to 2012 with 1,069 meeting the final inclusion criteria. Quality of life was assessed using the Expanded Prostate Index Composite (EPIC-26) and clinical data by chart review. Six quality measures were assessed, including pelvic lymphadenectomy with risk of lymph node involvement 2% or greater, appropriate nerve sparing, negative surgical margins, urinary and sexual function, treatment by high volume surgeon, and 30-day and 1-year complications. Receipt of high quality care was compared across categories of race, age, surgeon volume and surgical approach via multivariable analysis.
RESULTS: There were no significant differences in quality across race, age or surgeon volume strata, except for worse urinary incontinence in Black men. However, robotic surgery patients experienced fewer complications (3% vs 9.3% short-term and 11% vs 16% long-term), were more likely to be treated by a high volume surgeon (47% vs 25%) and demonstrated better sexual function.
CONCLUSIONS: In this cohort we did not identify meaningful variation in quality of care across racial groups, age groups and surgeon volume strata, suggesting that men are receiving comparable quality of care across these strata. However, we did find variation between open and robotic surgery with fewer complications, improved sexual function and increased use of high volume surgeons in the robotic group, possibly reflecting differences in quality between approaches, differences in practice patterns and/or biases in patient selection.
Volume
204
Issue
6
First Page
1236
Last Page
1241
ISSN
1527-3792
Published In/Presented At
Reisz, P. A., Laviana, A. A., Zhao, Z., Huang, L. C., Koyama, T., Conwill, R., Hoffman, K., Goodman, M., Hamilton, A. S., Wu, X. C., Paddock, L. E., Stroup, A., Cooperberg, M. R., Hashibe, M., O'Neil, B. B., Kaplan, S. H., Greenfield, S., Penson, D. F., & Barocas, D. A. (2020). Assessing the Quality of Surgical Care for Clinically Localized Prostate Cancer: Results from the CEASAR Study. The Journal of urology, 204(6), 1236–1241. https://doi.org/10.1097/JU.0000000000001198
Disciplines
Medicine and Health Sciences
PubMedID
32568605
Department(s)
Department of Medicine
Document Type
Article