Validation of quality indicators for radical prostatectomy

Abstract

The feasibility and validity of proposed radical prostatectomy quality indicators has not been well studied. We assessed indicator availability from treating charts. We tested the convergent construct validity of a modified subset that were available from this information source by correlating them to hospital prostatectomy volume, a variable repeatedly associated with the quality of surgical care. The study population consisted of a stratified random sample of prostate cancer patients who were: (i) diagnosed between 1990 and 1998 in Ontario and (ii) treated by radical prostatectomy with curative intent within 6 months of diagnosis (n 5 645). Of the 9 candidate quality indicators assessed, 4 were missing for 25-56% of study subjects and were not analyzed further. We discuss the implications of this missing information on feasibility of their use. For blood transfusions of 3 units or greater, length of hospital stay and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume. Acute complication rates and positive surgical margin rates did not increase with decreasing hospital volume. We were able to demonstrate convergent construct validity for 3 quality indicators. Upon further validation, this readily available information may be applied to aid providers and quality councils to more effectively identify problems and guide change in the management of early prostate cancer.

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

“…The positive margin rate in British Columbia in pT3 cases (57%) are also comparable to the range of regional rates seen in Ontario (42%-83%), 11 and within the ranges of rates reported in the literature (24%-80%). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In comparison to the recent large SEER series, need for, and use of, post prostatectomy radiotherapy our margin positive rates exceed those reported for SEER (18% for pT2, and 44% for pT3). 39 Unlike the SEER study, which was also population-based, our study detailed patient data on postoperative PSA, which allowed us to distinguish adjuvant and early salvage radiotherapy.…”

Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radical prostatectomy

“…The finding that surgery in a lower-volume hospital is associated with poorer long-term cause-specific survival is consistent with our a priori hypotheses and previous research, which has studied intermediate outcomes such as hospital readmission. [15][16][17][18][19][20][21][22][23][24][25][26] This volume effect was not due to older patients or patients with more severe disease or comor- Quality of care indicators and related outcomes bidities being referred to higher-volume centres. We are not aware of any other studies that have examined long-term survival following RP in relation to hospital volume.…”

Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

“…Results from those other objectives have been reported separately. 7,8 A stratified (by region of residence) random sample of about 10% of all patients and 59% of all cases formed the cohort (n = 1703) and case groups (n = 632, with 122 of selected for both the cohort and cases as per the casecohort design), for a total study population of 2213. Of these, 114 were ineligible or had insufficient treatment information available in the charts (Fig.…”