A New Era in Surgical Evaluation—What Is at Stake?

We commend Auffenberg et al¹ on their prospective cohort study in this issue of JAMA Surgery on patient-reported outcomes of urinary continence following radical prostatectomy. They found that top-performing surgeons consistently achieved higher patient-reported continence, regardless of risk group (independent of patient population). Interestingly, experience as represented by case volume did not appear to play a role in improving outcomes.² This implies that factors other than sheer volume play a role in determining who is a good surgeon. While most surgeons have an intuitive sense of what contributes to surgical skill, strategies to rigorously define and disseminate these characteristics will be critical in improving outcomes.