Kevin Gallagher, Steven MacLennan, Nikita Bhatt, Keiran Clement, Eleanor Zimmermann, Sinan Khadhouri, Meghana Kulkarni, Fortis Gaba, Thineskrishna Anbarasan, Aqua Asif, Alexander Light, Alexander Ng, Vinson Wai‐Shun Chan, Arjun Nathan, David Cooper, Lorna Aucott, Deerush Kannan Sakthivel, Murat Akand, Pietro Piazza, Gautier Marcq, Tim O’Brien, Matthew Nielsen, Francesco Del Giudice, Kenny Simpson, Luca Orecchia, Bernardo Teixeira, Daben Dawam, Alexander Geisenhoff, G Hill, Wataru Fukuokaya, Beatriz Gutiérrez Hidalgo, Albert El-Hajj, Mostafa Elgamal, Jack B. Fanshawe, Betty Wang, Taeweon Lee, Rustom P. Manecksha, Conor McCann, Juan Gomez Rivas, Ersan Arda, Muhammed Elhadi, Sabrina Rossi, Jeremy Yuen-Chun Teoh, Paramananthan Mariappan, Veeru Kasivisvanathan, Alessandro A. Princiotta, Nicolò Trabacchin, Alessandro Antonelli, Maria Angela A.A. Cerruto, Emanuele Rubilotta, Israa Hussein, Anna Longshaw, Nikolaos Kostakopoulos, Sinan A.S. Khadhouri, Anna E. Kruczynska, Konstantinos K.D. Dimitropoulos, Arthur McPhee, Kemal P. Gilanliogullari, Simon Natalie, Luca Rutigliani, Olivia R. Shallcross, Ibifuro I. Dokubo, Benjamin W. Lamb, Joachim H. Jimie, Baher Hussein, Abdulhakeem Bayomy, Hassan Abdelazim, Eslam Metwally M. Mohamed, Hesham Abozied, Rahul Jena, Amit Aggarwal, Gautam Ram R. Choudhary, Akshaya U. Upadhyay, Ankur Mittal, Vikas K. Panwar, Arup K. Mandal, Carole O’Neill, Abigail R. Nelson, Alex MacLeod, Elia Abou Chawareb, Elio E. Hoyek, Nassib Abou Heidar, Albert El-Hajj, Narasimhan Ragavan, Nitesh Jain, Deerush Kannan Sakthivel, Agusti Marfany Pluchart, Marta Viridiana V. Muñoz Rivero, Cayo Augusto C. Estigarribia Benitez, Nimalan Arumainayagam, Fouad Maqboul, Sachin Agrawal, Rajesh Kumar Reddy Adapala, Hannah Burns, Holly J. Bekarma, Antonio Andrea Grosso, Elena Ciaralli, Fabrizio Di Maida, Sofia Giudici, Andrea Minervini
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.