THE NATIONAL PROSTATECTOMY AUDIT - THE CLINICAL MANAGEMENT OF PATIENTS DURING HOSPITAL ADMISSION

Objective To determine everyday practice in the hospital management of men undergoing prostatectomy and the extent of its variation. Patient s and methods A total of 5361 patients, who represented 89% of all tho se undergoing prostatic procedures in four health regions (Mersey, Wes sex, Northern and South West Thames) and one test site (within Trent) were recruited by 103 (97%) surgeons. Clinical information was collect ed on a pre-coded data collection form which was completed during the hospital stay by the principal operator, Patient identification occurr ed at the time of surgery. Results Important findings included: (i) bo th older men and those of higher social class were more likely to unde rgo prostatectomy with fewer symptoms; (ii) men who waited longer for surgery had worse symptoms by the time of their operation: (iii) there were unexplained differences in routine pre- and post-operative inves tigation and treatment. Half the men had their flow rate or residual u rine measured as part of their pre-operative assessment. About half th e men received prophylactic antibiotics; (iv) when large groups were a nalysed, a consistent proportion of men throughout the study (12%) wer e undergoing the operation for a second time, The clinical course of m en having a repeat operation differed in many ways from those having a first time procedure; (v) the larger proportion of men (62%) had surg ery for strong indications as opposed to symptoms alone; (vi) although most operations were performed by consultants, emergency admissions, though symptomatically more severe and sicker, were more likely to be operated on by trainee surgeons; (vii) significant variation in mean p reoperative symptom severity and bother scores were seen between surge ons. Conclusion The clinical management of prostatectomy has been defi ned in a large and representative UK sample, In some circumstances con sistent variations have been identified, It is not yet clear whether t hese variations influence outcome, These data can be used by surgeons wishing to compare their own patient management with that described he re.