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.
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.
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]).
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.
European urology. 2025 Dec 10 [Epub ahead of print]
Kevin Gallagher, Steven MacLennan, Nikita Bhatt, Keiran Clement, Eleanor Zimmermann, Sinan Khadhouri, Meghana Kulkarni, Fortis Gaba MPhil, Thineskrishna Anbarasan, Aqua Asif, Alexander Light, Alexander Ng, Vinson Wai-Shun Chan, Arjun Nathan, David Cooper, Lorna Aucott, Deerush Sakthivel, Murat Akand, Pietro Piazza, Gautier Marcq, Tim O'Brien, Matthew Nielsen, Francesco Del Giudice, Keith Simpson, Luca Orecchia, Bernardo Teixeira, Daben Dawam, Alexander Geisenhoff, George Hill, Wataru Fukuokaya, Beatriz Gutiérrez Hidalgo, Albert El-Hajj, Mostafa Elgamal, Jack Fanshawe, Betty Wang, Taeweon Lee, Rustom Manecksha, Conor McCann, Juan Gomez Rivas, Ersan Arda, Muhammed Elhadi, Sabrina Rossi, Jeremy Yuen-Chun Teoh, Paramananthan Mariappan, Veeru Kasivisvanathan, BURST-RESECT Global Study Group
Institute of Genetics and Cancer, Cancer Informatics Group, University of Edinburgh, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom; British Urology Researchers in Surgical Training, London, United Kingdom; Department of Urology, Western General Hospital, Edinburgh, Scotland, UK. Electronic address: ., Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Urology, NHS Tayside, Dundee, Scotland, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Urology, North Bristol NHS Trust, Bristol, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; School of medicine, St Andrews University, St Andrews, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Urology, St. George's University Hospital London, London, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Urology, Albany Medical Center, Albany NY, USA., British Urology Researchers in Surgical Training, London, United Kingdom; Oxford University Hospitals, Oxford, United Kingdom., Division of Surgery and Interventional Science, University College London, London, United Kingdom; British Urology Researchers in Surgical Training, London, United Kingdom., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom., Division of Surgery and Interventional Science, University College London, London, United Kingdom; British Urology Researchers in Surgical Training, London, United Kingdom; Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom., Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom., Apollo Hospitals, Chennai, India., University Hospitals Leuven, Leuven, Belgium., IRCCS Azienda Ospedaliero Universitaria di Bologna - Policlinico Sant'Orsola Malpighi, Bologna, Italy; DIMEC Department, University of Bologna, Bologna, Italy., Centre Hospitalier Universitaire de Lille, France., Department of Urology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom., Department of Urology, University of North Carolina Medical School, Chapel Hill, NC, United States., Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Italy; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, London, UK., Department of Urology, Western General Hospital, Edinburgh, Scotland, UK., AOU Policlinico Tor Vergata, Rome, Italy., Centro Hospitalar e Universitário de Santo António, Porto, Portugal., Southend University Hospital, Southend, UK., Beaumont Hospital, Royal Oak, USA., Morriston Hospital, Swansea, United Kingdom., The Jikei University Kashiwa Hospital, Kashiwa, Japan; The Jikei University School of Medicine, Tokyo, Japan., Hospital Clínico San Carlos, Madrid, Spain., Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon., Urology and Nephrology Center, Mansoura, Egypt., Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Lewisham and Greenwich NHS Trust, London, United Kingdom., Department of Urology, University of Alberta, Edmonton, Alberta, Canada., Department of Urologic Sciences, Vancouver, British Columbia, Canada., Dept. Of Surgery, Trinity College Dublin, Dublin, Ireland; Trinity College Dublin group, Ireland., Belfast City Hospital, Belfast, Ireland., Universidad Complutense de Madrid, Spain., Trakya University, Health Center for Medical Research and Practice, Edirne, Turkey., Faculty of Medicine, University of Tripoli, Tripoli, Libya., British Urology Researchers in Surgical Training, London, United Kingdom; Department of Surgery, University of Cambridge, Cambridge Biomedical Centre, Cambridge, UK., S H Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong., Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital Edinburgh, Edinburgh, United Kingdom; The University of Edinburgh, United Kingdom.