Validation of quality indicators for radical prostatectomy

Abstract

The feasibility and validity of proposed radical prostatectomy quality indicators has not been well studied. We assessed indicator availability from treating charts. We tested the convergent construct validity of a modified subset that were available from this information source by correlating them to hospital prostatectomy volume, a variable repeatedly associated with the quality of surgical care. The study population consisted of a stratified random sample of prostate cancer patients who were: (i) diagnosed between 1990 and 1998 in Ontario and (ii) treated by radical prostatectomy with curative intent within 6 months of diagnosis (n = 645). Of the 9 candidate quality indicators assessed, 4 were missing for 25-56% of study subjects and were not analyzed further. We discuss the implications of this missing information on feasibility of their use. For blood transfusions of 3 units or greater, length of hospital stay and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume. Acute complication rates and positive surgical margin rates did not increase with decreasing hospital volume. We were able to demonstrate convergent construct validity for 3 quality indicators. Upon further validation, this readily available information may be applied to aid providers and quality councils to more effectively identify problems and guide change in the management of early prostate cancer.