NEW YORK (Reuters Health) – Whether or not men have good sexual-function outcomes after radical prostatectomy may depend on the surgeon, according to a study that found substantial surgeon-level variation in sexual-function outcomes in the two years after surgery.
“Variation in surgeon-level sexual function outcomes presents an opportunity and model for surgical collaborative quality improvement,” researchers write in JAMA Surgery.
The Michigan Urological Surgery Improvement Collaborative (MUSIC) Patient Reported Outcomes (PRO) web-based system assesses patient recovery following radical prostatectomy. Using this registry, the researchers evaluated patient- and surgeon-level variation in EPIC-26 sexual-domain scores and sexual-function recovery in 1,426 men (median age, 64; 84% white) who underwent RP.
Among patients undergoing bilateral nerve-sparing radical prostatectomy, mean EPIC-26 sexual function scores at 12- and 24-month follow-up did not return to baseline levels,” report Dr. Nnenaya Agochukwu-Mmonu of the Department of Urology, New York University, and colleagues.
They found “wide variation in patient-reported sexual function outcomes at the patient and surgeon level, which persisted when controlling for patient characteristics.”
Some surgeons had up to 40% of patients recover sexual function at 12 months while others had none. Surgeon case volume and sexual-function outcomes were not significantly correlated.
“Surgeon-level variation in sexual function outcomes among patients undergoing radical prostatectomy may present an opportunity for collaborative quality improvement,” the authors conclude.
In an invited commentary in the journal, Dr. Jeffery Vehawn and Dr. Brock O’Neil of the Huntsman Cancer Institute, University of Utah, Salt Lake City, say the foundation of this study is “remarkable.”
“It remains quite rare for surgeons to permit such detailed information about outcomes tied to surgical skill to be compared to others. This speaks to the incredible trust cultivated among members of MUSIC and serves as a model for transformative surgical collaborations,” they write.
The fact that there was no correlation between surgical volume and sexual function contradicts other studies that have examined the relationship between surgical volume and complications, quality of life, and sexual function.
“It is possible that the inclusion criterion requiring surgeons to have operated on at least 10 men with good baseline sexual function over a 5-year period obscured this previously observed phenomenon. That is, a volume-outcome relationship may not be observed among surgeons who are well established on the learning curve,” write Dr. Vehawn and Dr. O’Neil.
“Reporting and understanding surgeon-level variation in outcomes represents a big step in collaborative surgical improvement. Whether such an approach can be efficiently leveraged to meaningful improvement in outcomes remains to be seen,” they conclude.
SOURCE: https://bit.ly/3luYpmh and https://bit.ly/3lrfv4M JAMA Surgery, online December 1, 2021.
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