About the Audit
Radical prostatectomy is the removal of the whole prostate gland and seminal vesicles for cancer of the prostate. The operative technique used may be open, laparoscopic or robotic-assisted. In recent years, an increasing number of procedures are undertaken using the last of these techniques with 84% of radical prostatectomies reported here being robotically-assisted.
Although the BAUS Section of Oncology has been running a radical prostatectomy audit since 2003, this is only the fifth year that individual outcomes data have been made publicly available.
The Section has decided to keep the published data as simple as possible. We have, therefore, only listed the number of operations performed by technique, the transfusion rate, length of stay (LOS) and major post-operative complications (Clavien Dindo grade III and above). We have also included an average patient risk profile which shows the percentage risk that surgeons' / hospitals' patients have in relation to pre-operative PSA, Gleason score, pathological T2c and T3, and body mass index.
BAUS are aware that there are considerable gaps in the data (e.g. in 10% of the cases entered, there is no record of complications). The complication rate in the BAUS audit is lower than the published literature would suggest; as a result, surgeons who have diligently recorded their complications may appear to have an above average complication rate. Where there appears to be a high complication or transfusion rate, BAUS has sought explanation from the surgeons involved; they have entered into dialogue with BAUS and we commend them, both for the accuracy with which they have recorded their data and for their engagement in this process.
This is the first step in a lengthy project and we accept that it may have flaws. However, in the long term, this audit will deliver good quality data and will be a valuable tool in improving care. The Section of Oncology, in consultation with the wider membership, will continue to review the analysed data to identify any additional outcome indicators which may have potential uses in future years.
Cumulative data from previous years are available on the Data & Audit pages of the Professionals section.
Interpretation of the data
Because this is only the third year of publication for radical prostatectomy data, there is insufficient information for risk adjustment, but this should be possible in future years.
The data presented are surgeon-reported. There is, therefore, no method for reliably validating the data other than by comparing them with the latest Hospital Episode Statistics (HES).
There are no financial incentives (or sanctions) for hospitals and Trusts to support collection of radical prostatectomy data, and this may also account for the data being incomplete.