The following is a summary of “Surgeon-level versus hospital-level quality variance in kidney cancer surgery,” published in the May 2023 issue of the Urologic Oncology by McAlpine et al.

This study aims to determine whether surgeon-level or hospital-level factors primarily influence variation in kidney cancer surgery quality indicators (QIs) to inform quality improvement initiatives. The ICES and Veterans Affairs (VA) databases were queried for patients with localized kidney cancer undergoing surgery. Within each cohort, quality indicators for kidney cancer surgery were established. To identify statistical outliers, the quality of care was compared between surgeons and hospitals using available clinicopathological data to account for differences in case mix. 

The variance between surgeons and hospitals was computed using a random-effects model for each QI. The proportion of cases performed with minimally invasive surgery (MIS) exhibited the maximum variance explained by the hospital- and surgeon-level factors. For both the VA and ICES cohorts, surgeon-level factors accounted for the preponderance of this variance. The proportion of cases performed using a minimally invasive surgery (MIS) technique was also the QI, with the most significant number of hospitals and surgeons serving significantly above or below the mean. 

For the ICES cohort, the proportion of partial nephrectomies performed on patients at risk for chronic kidney disease was the QI with the most significant variance attributable to hospital-level factors. The proportion of localized renal cancer cases treated with minimally invasive surgery is the metric requiring the most attention. Quality enhancement initiatives should target surgeon-level factors to increase the number of minimally invasive surgeries (MIS) performed on patients with localized renal masses.

Source: sciencedirect.com/science/article/abs/pii/S1078143923000807