In Reply: Dr Lowrance and colleagues highlight the challenges of using administrative data to assess complications related to treatment and procedures, particularly in identifying functional outcomes. Although studies demonstrate that Medicare claims have high validity for detecting short-term surgical and stricture complications,1 use of claims data for assessment of long-term functional outcomes is subject to bias related to differential coding by surgeons or differences in patient reporting. Claims data also likely under-ascertain these conditions because men who are not too bothered by postprostatectomy incontinence or erectile dysfunction may not seek medical attention. Self-assessment with validated quality-of-life instruments can provide a more precise measure of these outcomes.
Hu JC, D’Amico AV, Keating NL. Minimally Invasive vs Open Radical Prostatectomy—Reply. JAMA. 2010;303(7):619-620. doi:10.1001/jama.2010.127