Surgical quality is more than volume: the association between changing urologists and complications for patients with localized prostate cancer

Objectives: To examine the association of changing urologists on surgical complications in men with prostate cancer.

Data sources/study setting: Registry and administrative claims data from the Surveillance, Epidemiology, and End Results-Medicare database from 1995 to 2005.

Study design: A cross-sectional observational study of men with prostate cancer who underwent radical prostatectomy.

Methods: Subjects were classified as having "changed urologists" if they had a different urologist who diagnosed their cancer from the one who performed their surgery. "Doubly robust" propensity score weighted multivariable logistic regression models were used to investigate the effect of changing urologists on 30-day surgical complications, late urinary complications, and long-term incontinence.

Principal findings: Men who changed urologists between diagnosis and treatment had significantly lower odds of 30-day surgical complications compared with men who did not change urologists (odds ratio: 0.82; 95 percent confidence interval: 0.76-0.89), after adjustment. Changing urologists was associated with lower risks of 30-day complications for both black and white men compared with staying with the same urologist for their diagnosis and surgical treatment.

Conclusions: Urologist changing is associated with the observed variation in complications following radical prostatectomy. This may suggest that patients are responding to aspects of surgical quality not captured in surgical volume.