Quantifying severe urinary complications after radical prostatectomy: the development and validation of a surgical performance indicator using hospital administrative data.

To develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within two years after radical prostatectomy (RP) identified in hospital administrative data.

Men who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding-framework based on procedure codes was developed to identify severe urinary complications which were grouped into "stricture", "incontinence" and "other". Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression to estimate adjusted odds ratios (OR) for patient and surgical characteristics.

17,299 men were included, 2,695 (15.6%) experienced at least one severe urinary complication within two years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds(OR comparing lowest with highest quintile: 1.45; 95%CI, 1.26-1.67) and those with prolonged length of hospital stay (OR 1.54, 95% CI, 1.40-1.69) and were less common in men who had robotic surgery (OR 0.65, 95% CI, 0.58-0.74).

These results demonstrate severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment modalities and for service evaluation comparing performance of prostate cancer surgery providers. This article is protected by copyright. All rights reserved.

BJU international. 2017 Jan 11 [Epub ahead of print]

A Sujenthiran, S C Charman, M Parry, J Nossiter, A Aggarwal, P Dasgupta, H Payne, N W Clarke, P Cathcart, J van der Meulen

Clinical Effectiveness Unit, Royal College of Surgeon of England, United Kingdom., London School of Hygiene and Tropical Medicine, London, United Kingdom., MRC Centre for Transplantation, King's College London, London, United Kingdom., Department of Oncology, University College London Hospitals, London, United Kingdom., Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom., Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

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