Does “changing urologists” improve outcomes after surgery?

In what appears to be a fascinating study from a group of researchers at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore come data suggesting that patients who “changed urologists” had better short-term surgical outcomes after radical prostatectomy. So the question has to be, what did the research team mean by “changed urologists”?

Dugoff et al. used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 1995 to 2005 to conduct this study, and they defined “changed urologists” to mean that the patient received his surgery from a different urologist to the one that made the initial diagnosis.

The principal findings of their study were that:

  • Men who “changed urologists” between diagnosis and treatment had significantly lower risk for surgical complications within 30 days of surgery compared with men who did not change urologists (odds ratio [OR] = 0.82).
  • This reduction in risk was observed among both African-American and white patients.

The authors conclude that their data “may suggest that patients are responding to aspects of surgical quality not captured in surgical volume.”

One always has to be careful in interpreting data from a study like this, which is based in part on administrative as opposed to actual clinical data. And The “New” Prostate Cancer InfoLink has only seen the abstract of this paper, not the full text article. However, there are good potential reasons to believe that separation of initial diagnosis from treatment may benefit patients:

  • Being able to diagnose prostate cancer with great accuracy does not make one a great prostate cancer surgeon.
  • Just doing a lot of radical prostatectomies does not make one a great surgeon either; one has to be able to do them well!
  • In recent years we have started to see the development of truly high volume/high skill level centers at which small numbers of surgeons are very highly focused, nearly exclusively, on prostate cancer surgery.

Now surgery is certainly not the only appropriate form of treatment for prostate cancer, but it is certainly the case that surgery comes with a potentially high level of risk for complications — in the short term and the longer term, and more data that help patients to understand how to minimize risk for complications of surgery are definitely a good idea.

Having said that, the abstract of this paper does not state that those patients who “changed urologists” necessarily had better long-term outcomes in terms of risk for long-term incontinence or surgical complications after 30 days, so there is “good news” and “less good news” associated with the data from this article.

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