What has to happen before we report radical prostatectomy outcomes of individual surgeons to the public?

Overview

It would appear entirely uncontroversial to suggest that prostate cancer patients should have available information on surgeon outcomes so that they can make informed treatment decisions. We argue that release of surgeon-level data on radical prostatectomy outcomes would be premature at the current time. We point to a series of problems that would need to be addressed before we could be sure that a consumerist approach to surgeon selection would do more good than harm. These include non-standardized reporting of endpoints such as urinary and erectile function, statistically unreliable estimates from low volume surgeons and perverse incentives, such as referring of high risk patients to radiotherapy. We recommend an alternative to the “name-and-shame” paradigm of public outcomes reporting: continuous quality improvement. Surgeons are given reports as to their own outcomes on a private basis, such that no-one else can see their data. This helps to build trust and to avoid perverse incentives. Such reports must be multi-dimensional and based on a comprehensive, patient-reported outcomes system. As outcomes data are meaningless for low volume surgeons, these surgeons would have to choose between focusing on radical prostatectomy and referring patients to higher volume colleagues. Systematic research is required to determine whether such an approach would do more good than harm.