Resect: A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery

TY - JOUR

T1 - Resect

T2 - A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery

AU - Gallagher, Kevin

AU - MacLennan, Steven

AU - Bhatt, Nikita

AU - Clement, Keiran

AU - Zimmermann, Eleanor

AU - Khadhouri, Sinan

AU - Kulkarni, Meghana

AU - Gaba, Fortis

AU - Anbarasan, Thineskrishna

AU - Asif, Aqua

AU - Light, Alexander

AU - Ng, Alexander

AU - Chan, Vinson Wai-Shun

AU - Nathan, Arjun

AU - Cooper, David

AU - Aucott, Lorna

AU - Sakthivel, Deerush

AU - Akand, Murat

AU - Piazza, Pietro

AU - Marcq, Gautier

AU - O'Brien, Tim

AU - Nielsen, Matthew

AU - Giudice, Francesco Del

AU - Simpson, Keith

AU - Orecchia, Luca

AU - Teixeira, Bernardo

AU - Dawam, Daben

AU - Geisenhoff, Alexander

AU - Hill, George

AU - Fukuokaya, Wataru

AU - Hidalgo, Beatriz Gutiérrez

AU - El-Hajj, Albert

AU - Elgamal, Mostafa

AU - Fanshawe, Jack

AU - Wang, Betty

AU - Lee, Taeweon

AU - Manecksha, Rustom

AU - McCann, Conor

AU - Rivas, Juan Gomez

AU - Arda, Ersan

AU - Elhadi, Muhammed

AU - Rossi, Sabrina

AU - Teoh, Jeremy Yuen-Chun

AU - Mariappan, Paramananthan

AU - Kasivisvanathan, Veeru

N1 - Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.

PY - 2026/3/18

Y1 - 2026/3/18

N2 - BACKGROUND AND OBJECTIVE: We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates.METHODS: This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome.KEY FINDINGS AND LIMITATIONS: A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]).CONCLUSIONS AND CLINICAL IMPLICATIONS: Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes.

AB - BACKGROUND AND OBJECTIVE: We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates.METHODS: This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome.KEY FINDINGS AND LIMITATIONS: A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]).CONCLUSIONS AND CLINICAL IMPLICATIONS: Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes.

KW - Humans

KW - Urinary Bladder Neoplasms/surgery

KW - Male

KW - Female

KW - Cystectomy/methods

KW - Aged

KW - Neoplasm Recurrence, Local/prevention & control

KW - Middle Aged

KW - Medical Audit

KW - Neoplasm Invasiveness

KW - Treatment Outcome

KW - Formative Feedback

KW - Clinical Competence

KW - Non-Muscle Invasive Bladder Neoplasms

U2 - 10.1016/j.eururo.2025.09.4174

DO - 10.1016/j.eururo.2025.09.4174

M3 - Article

C2 - 41444076

SN - 0302-2838

VL - 89

SP - 355

EP - 365

JO - European Urology

JF - European Urology

IS - 4

ER -