The implementation of quality assurance programs (QAPs) within urological practice has gained prominence; yet, their impact on outcomes after radical prostatectomy (RP) remains uncertain. This paper aims to systematically review the current literature regarding the implementation of QAPs and their impact on outcomes after robot-assisted RP, laparoscopic RP, and open prostatectomy, collectively referred to as RP.
A systematic Embase, Medline (OvidSP), and Scopus search was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) process, on January 12, 2024. Studies were identified and included if these covered implementation of QAPs and their impact on outcomes after RP. QAPs were defined as any intervention seeking quality improvement through critically reviewing, analyzing, and discussing outcomes. Included studies were assessed critically using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool, with results summarized narratively.
Ten included studies revealed two methodological strategies: periodic performance feedback and surgical video assessments. Despite conceptual variability, QAPs improved outcomes consistently (ie, surgical margins, urine continence, erectile function, and hospital readmissions). Of the two strategies, video assessments better identified suboptimal surgical practice and technical errors. Although the extent of quality improvements did not appear to correlate with the frequency of QAPs, there was an apparent correlation with whether or not outcomes were evaluated collectively.
Current findings suggest that QAPs have a positive impact on outcomes after RP. Caution in interpretation due to limited data is advised. More extensive research is required to explore how conceptual differences impact the extent of quality improvements.
In this paper, we review the available scientific literature regarding the implementation of quality assurance programs and their impact on outcomes after radical prostatectomy. The included studies offered substantial support for the implementation of quality assurance programs as an incentive to improve the quality of care continuously.
European urology focus. 2024 Apr 16 [Epub ahead of print]
Sophia H van der Graaf, Marinus J Hagens, Hans Veerman, Ton A Roeleveld, Jakko A Nieuwenhuijzen, Esther M K Wit, Michel W J M Wouters, Stevie van der Mierden, R Jeroen A van Moorselaar, Harrie P Beerlage, André N Vis, Pim J van Leeuwen, Henk G van der Poel
Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands; Prostate Cancer Network Netherlands, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands; Prostate Cancer Network Netherlands, Amsterdam, The Netherlands., Prostate Cancer Network Netherlands, Amsterdam, The Netherlands; Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands., Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands; Prostate Cancer Network Netherlands, Amsterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands; Prostate Cancer Network Netherlands, Amsterdam, The Netherlands., Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands; Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands., Scientific Information Service, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.