The Impact of Open Surgical Team Consistency on Oncologic and Functional Outcomes Following Radical Prostatectomy

Abstract

Objective

To evaluate the impact of surgical team consistency on patient outcomes following radical prostatectomy (RP).

Patients and Methods

Patients undergoing RP at a single institution from 2010 to 2019 were identified. The surgical care team comprised three members: a certified surgical assistant, a certified surgical technologist, and a circulating nurse. Primary team member status for each of the three roles was assigned on a quarterly basis to team members who were present for the highest proportion of a surgeon’s cases. For each procedure, the surgical care team present at the time of the surgical timeout was assessed. Low-consistency teams were defined as those with zero to one primary team members present for a procedure, and high-consistency teams were defined as those with two to three primary team members present. Outcomes included prostate cancer recurrence as well as urinary continence and erectile function (assessed at 1 year after surgery). Cox-proportional hazard regression models evaluated the association of care team consistency with oncologic outcomes, controlling for clinicopathologic variables.

Results

Overall, 4188 of 6216 (67.3%) RPs were performed with high-consistency teams. High-consistency surgical teams were associated with significantly improved 5-year prostate cancer recurrence-free survival (76% vs 72.9%; P=.009). On multivariable analysis, high-consistency teams remained significantly associated with a lower rate of prostate cancer recurrence (HR, 0.93; P=.01). One year postoperatively, high-consistency teams had significantly higher urinary continence rates (0-1 pads/d) (93.9% vs 90.3%; P<.0001) and lower rates of erectile dysfunction (32.9% vs 35.2%; P=.02).

Conclusion

High-consistency surgical teams during RP are associated with significantly lower rates of prostate cancer recurrence and improved functional outcomes.