Performance Feedback May Not Improve Radical Prostatectomy Outcomes: The Surgical Report Card (SuRep) Study.
Oncologic, urinary, and sexual outcomes are important to patients receiving prostate cancer surgery. The objective of this study was to determine if providing surgical report cards (SuRep) to surgeons resulted in improved patient outcomes.A prospective before-and-after study was conducted at The Ottawa Hospital. 422 consecutive patients undergoing radical prostatectomy were enrolled. The intervention was provision of report cards to surgeons. The control cohort was patients treated before report card feedback (pre-SuRep), and the intervention cohort was patients treated after report card feedback (post-SuRep). The primary outcomes were post-operative erectile function, urinary continence, and positive surgical margins.Baseline characteristics were similar between groups. Almost all patients were continent (99%) and the majority were potent (59%) prior to surgery. Complete 1-year follow up was available for 397 (94%) of patients. Nerve sparing surgery increased from 70% pre-SuRep to 82% post-SuRep (p=0.01). There was a non-statistically significant increase in the proportion of patients with a positive surgical margin post-SuRep (31% pre-SuRep vs 39% post-SuRep; p=0.08). There was no difference in post-operative erectile function (17% vs 18%; p=0.7) and a decrease in continence (75% vs 65%; p=0.02) at 1-year post-surgery.The SuRep platform allows for accurate reporting of surgical outcomes that can be used for patient counseling. However, the provision of surgical report cards did not improve functional or oncological outcomes. Longer durations of feedback, report card modifications, or targeted interventions are likely necessary to improve outcomes.
Authors: Ravi M Kumar, Dean A Fergusson, Luke T Lavallée, Ilias Cagiannos, Christopher Morash, Michael Horrigan, Ranjeeta Mallick, Dawn Stacey, Michael Fung-Kee Fung, David Sands, Rodney H Breau