How do you know if you are any good? A surgeon performance feedback system for the outcomes of radical prostatectomy

Variation in outcomes Surgery remains a mainstay of initial treatment for prostate cancer, with an estimated 85,000 operations per year in the US. Radical prostatectomy is associated with important risks of erectile dysfunction, urinary incontinence and, naturally, cancer recurrence. Given the possible consequences, it would be reassuring were it known that urologic surgeons offer uniformly high-quality care. Unfortunately, the data suggest that this is far from the case. There is copious evidence that surgeons with greater case volume or total lifetime experience have better outcomes. For example, low volume surgeons have complication rates 6 to 8% greater than their higher volume counterparts[1]; in studies on the learning curve, the risk of recurrence is about 7% higher for a typical patient treated by an inexperienced surgeon than if treated by a more experienced surgeon[2, 3] There are also data that differences in outcome go over and above characteristics such as volume or experience, with large variations between surgeons even within volume categories[1, 4], with one study reporting a five-fold variation in potency rates between surgeons at a single institution[5]. The extent of differences in outcome between different surgeons, as demonstrated in these studies, suggests that many patients are receiving suboptimal care. This raises the issue of how to improve the results of underperforming surgeons.