Population-based, nationwide registration of prostatectomies in Sweden

Abstract

Introduction: Radical prostatectomy (RP) is a common surgical procedure with a risk of postoperative erectile dysfunction and urinary incontinence. There is a need for data on RP as a basis for quality assurance and benchmarking.

Methods: In 2015, prostatectomies in Sweden (PiS) form was implemented in the National Prostate Cancer Register (NPCR) of Sweden with data on pre-, peri- and post-operative variables.

Results: Out of all radical prostatectomies performed in 2016 in Sweden, 3096/3881 (80%) were registered in PiS. A total of 2605 (84%) were robot-assisted radical prostatectomy (RARP) and 491 (16%) were RRP (retropubic radical prostatectomy). RARP was performed by 91 surgeons of whom 47% operated more than 25 RP/year; and RRP was performed by 69 surgeons of whom 10% performed more than 25 RP/year. RARP had a longer operative time (median operating time: RARP 155 minutes [IQR 124-190]; RRP 129 minutes [IQR 105-171]; P < .001) but was associated with smaller bleeding (median intraoperative blood loss: RARP 100 mL [IQR 50-200], RRP 700 mL [IQR 500-1100]; P < .001).

Conclusions: We report on a nationwide, population-based register with transparent reporting of data on the performance of radical prostatectomy. These data are needed as a basis for quality assurance with comparisons of results from individual surgeons and hospitals.

Keywords: NPCR; prostate cancer; radical prostatectomy; registry.

Figure 1

Display of proportion of positive margin per surgeon at a department, the mean for all surgeons at the hospital, and the mean for all surgeons in the nation. Data for a department are displayed 24 hours after reporting at the secured server Information Network for Cancer Care for this department, several other variables besides positive margins including operating time and preoperative blood loss are also reported in a similar fashion. The demonstrated data are fictitious [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Number of radical prostatectomies registered in The Patient Registry only, Patient Registry and in the prostatectomies in Sweden (PiS) form, and in PiS only in 2016 [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Number of radical prostatectomies recorded in prostatectomy in Sweden for each hospital in 2016. Area between vertical lines represents the number of RP's for each single surgeon. Red dashed line represents limit for low volume (50 RP's/year) as defined in the Swedish National Prostate Cancer Care programme (at least two surgeons that each perform 25 or more RP's). Departments where less than 5 RP's are not displayed. RP, radical prostatectomy [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

Age‐standardized incidence of prostatectomies per county in Sweden in 2016. No data were delivered from the county of Jämtland regarding RP performed in 2016 to NPCR. In the Jämtland county the incidence of RRP and RRP combined was 157/100.000 according to the Patient Registry. RP, Radical prostatectomy; RRP, retropubic radical prostatectomy [Color figure can be viewed at wileyonlinelibrary.com]