Surgical Team Composition and Outcomes After Radical Prostatectomy for Prostate Cancer

Physician assistants (PAs) and nurse practitioners (NPs) are increasingly integrated into surgical teams. Although their training varies, existing literature often considers PAs and NPs interchangeable when assessing their impact. The aim of this study was to measure the effects of PA vs NP team composition on surgical outcomes in men with prostate cancer.

We performed a retrospective cohort study using a 20% national sample of traditional Medicare beneficiaries undergoing radical prostatectomy between January 2010 and December 2020. The cohort included patients treated by independent urology groups with at least 1 PA or NP. Groups were stratified into 3 mutually exclusive categories: PA only, NP only, and both PA and NP. Generalized estimating equations measured the association between provider composition and surgical outcomes (ie, postoperative complications, prolonged length of hospitalization, and readmission within 90 days), adjusting for patient-level and group-level variables.

Over the study period, 424 independent urology groups with at least 1 PA or NP managed 8975 men undergoing radical prostatectomy. Patient age, race, and comorbidity were similar across team compositions. After adjustment, there was no association between team composition and complications, prolonged length of hospitalization, or readmission (P > .05 for all outcomes). For example, complications occurred in 9.8%, 11.4% and 11.5% of men managed by the PA-only, NP-only, and both PA and NP groups, respectively.

Among independent urology practices performing radical prostatectomy, outcomes did not differ between practices employing only PAs, only NPs, or both PAs and NPs. These findings suggest that employing PAs, NPs, or a combination is not associated with differences in postoperative outcomes.