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Standards for surgical complication reporting in urologic oncology: time for a change
1Department of Urology, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York 10021, USA. donats@mskcc.org
Objectives:
No standards for reporting surgical morbidity exist in the urologic oncology literature, yet surgical outcomes are used to assess the success of surgical techniques and surgeon competency. This study analyzes the quality of complication reporting in the urologic literature.
Methods:
Reports identified by a MEDLINE search reporting surgical outcomes after radical prostatectomy, radical cystectomy, retroperitoneal node dissection, and radical/partial nephrectomy were analyzed using 10 established criteria for surgical complication reporting. Open (n = 73) and minimally invasive (n = 36) surgical series of 50 patients or more published from January 1995 to December 2005 were reviewed.
Results:
A total of 109 studies reporting the outcomes for 146,961 patients, including 95 retrospective (87%), 11 prospective (10%), 1 randomized (1%), and 2 population-based (2%) studies were analyzed. Of the 10 critical reporting elements, 2% met 9 to 10, 21% met 7 to 8, 43% met 5 to 6, 30% met 3 to 4, and 4% met 1 to 2 criteria. The most commonly underreported criteria were complication definitions in 79%, complication severity/grade in 67%, outpatient data in 63%, comorbidities in 59%, and the duration of the reporting period in 56%. Additionally, 47% of minimally invasive surgical series met fewer than 5 of the 10 reporting criteria compared with 28% of open series. Of the 36 studies reporting complication severity, a numeric grading system was used in 7 (19%), with 29 (81%) of 36 using a "major versus minor" categorization but using 26 different definitions of what constituted "major."
Conclusions:
The disparity in the quality of surgical complication reporting in urologic oncology makes it impossible to compare the morbidity of surgical techniques and outcomes. Standard guidelines need to be established.
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