1754 PERIOPERATIVE OUTCOMES AFTER RADICAL CYSTECTOMY: THE IMPACT OF RESIDENCY AND FELLOWSHIP TRAINING

Background: Enhanced recovery after surgery (ERAS) protocols decrease the length of hospital stay (LOS) and complications following radical cystectomy (RC). However, the impact of non-modifiable patient factors to postoperative outcome is unclear. This study aimed to identify nonmodifiable patient and disease factors predictive of post-RC outcomes with ERAS protocols. Methods: We reviewed our institutional review board-approved prospectively maintained bladder cancer database. Patients with primary urothelial bladder cancer who underwent open RC with ERAS protocol between 2012 and 2016 were identified. Patient demographic and disease-relevant variables were reviewed. Factors predictive of LOS, 30- and 90-day complications and readmission were assessed using univariate and multivariable analyses. Results: A total of 289 patients with a median age of 70 years were included, of whom 80.6% were male, 33.6% had Charlson comorbidity index ⩾2. Median LOS was 4 days and 21.1% received intraoperative transfusion. The 30-day complication and readmission rates were 58.8% and 16.6%, respectively. Age >70 ( p = 0.02), Charlson comorbidity index ⩾2 ( p = 0.005), and intraoperative transfusion ( p = 0.03) were significantly associated with LOS. Intraoperative transfusion was significantly associated with 30-day complication and readmission ( p = 0.008, p = 0.005, respectively). No factor was found to be significantly associated with 90-day complication or readmission. Conclusions: With ERAS protocol, non-modifiable patient and disease factors influence outcomes after RC. Risk adjustment for these factors is important for patient counseling, quality assessment and future reimbursement.

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Sarcopenia as a predictor of perioperative outcomes following radical cystectomy in a contemporary cohort of patients with bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16031 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16031-e16031

Author(s):

Nicholas Brent Drury ◽

William Mills Worrilow ◽

Hamza Mustafa Beano ◽

Myra M. Robinson ◽

Jeffrey Ignatoff ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Care Pathway ◽

Perioperative Outcomes ◽

International Consensus ◽

Consensus Definition ◽

Cancer Specific Survival ◽

Perioperative Care Pathway ◽

The Impact

e16031 Background: Sarcopenia has gained considerable recognition as an important prognostic factor for complications, longer hospital stay, and survival following cystectomy for bladder cancer. However, inconsistent cutoff values to define sarcopenia have been utilized throughout the literature. Our aim was to evaluate sarcopenia as a predictor of outcomes following radical cystectomy with urinary diversion (RCUD) using the international consensus definition, Martin criteria, and Mayr criteria, as a standardized cutoff value would potentially reduce bias across studies. Methods: A retrospective analysis of patients treated with RCUD at our institution between 2010 and 2017 was performed. Sarcopenia was defined according to the aforementioned criteria and assessed by measuring total psoas area (TPA) on preoperative computerized tomography. The impact of sarcopenia on perioperative outcomes, cancer-specific survival (CSS), and overall survival (OS) was evaluated with univariate and multivariate regression models. Results: Of 258 patients who underwent RCUD, 195 had available computed tomography scans within 90 days of surgery. The median TPA scores among men and women were 578.0 and 459.6 mm2/mm2, respectively. The overall incidence of sarcopenia according to the international consensus definition, Martin criteria, and Mayr criteria was 36.4% (71/195), 24.1% (47/195), and 31.3% (61/195), respectively. Regardless of definition, significant differences were not observed in length of stay, high grade complications, readmissions, and discharge destination (all P > .05). Furthermore, sarcopenia was not significantly associated with CSS or OS. The median follow-up time was 4.1 years (95% CI: 3.6 - 4.4). The 5-year CSS and OS were 46.3% and 66.2%, respectively. Conclusions: Irrespective of definition, we were unable to externally validate sarcopenia as a predictor of perioperative outcomes in our contemporary cohort. Future studies will evaluate the impact of our evolving perioperative care pathway on oncological outcomes, including its ability to mitigate the effects of sarcopenia through reducing the physiological and mental demands of surgery.

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The impact of hospital volume, residency, and fellowship training on perioperative outcomes after radical prostatectomy

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2012.10.008 ◽

2014 ◽

Vol 32 (1) ◽

pp. 29.e13-29.e20 ◽

Cited By ~ 26

Author(s):

Quoc-Dien Trinh ◽

Maxine Sun ◽

Simon P. Kim ◽

Jesse Sammon ◽

Keith J. Kowalczyk ◽

...

Keyword(s):

Radical Prostatectomy ◽

Hospital Volume ◽

Fellowship Training ◽

Perioperative Outcomes ◽

The Impact

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Evaluating the impact of the learning curve on the perioperative outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion

Actas Urológicas Españolas (English Edition) ◽

10.1016/j.acuroe.2021.05.004 ◽

2021 ◽

Author(s):

C. López-Molina ◽

A. Carrion ◽

M. Campistol ◽

A. Piñero ◽

F. Lozano ◽

...

Keyword(s):

Learning Curve ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Perioperative Outcomes ◽

Robot Assisted ◽

The Impact ◽

Intracorporeal Urinary Diversion

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Multi-Institutional Analysis of Robotic Radical Cystectomy for Bladder Cancer: Perioperative Outcomes and Complications in 227 Patients

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2011.0326 ◽

2012 ◽

Vol 22 (1) ◽

pp. 17-21 ◽

Cited By ~ 77

Author(s):

Angela B. Smith ◽

Mathew Raynor ◽

Christopher L. Amling ◽

J. Erik Busby ◽

Erik Castle ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Institutional Analysis ◽

Perioperative Outcomes ◽

Robotic Radical Cystectomy

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Effects of COVID-19 on Facial Plastic and Reconstructive Surgery Fellowship Training and Director Practices

OTO Open ◽

10.1177/2473974x211014130 ◽

2021 ◽

Vol 5 (2) ◽

pp. 2473974X2110141

Author(s):

Parsa P. Salehi ◽

Sina J. Torabi ◽

Yan Ho Lee ◽

Babak Azizzadeh

Keyword(s):

Facial Nerve ◽

Reconstructive Surgery ◽

Trauma Surgery ◽

The United States ◽

Fellowship Training ◽

Craniofacial Surgery ◽

Worker Safety ◽

Plastic And Reconstructive Surgery ◽

Facial Plastic ◽

The Impact

Objectives The objectives of this study include characterizing the practice patterns and testing strategies of facial plastic and reconstructive surgery (FPRS) fellowship directors (FDs) secondary to COVID-19 and to quantify the impact of COVID-19 on FPRS fellowship training. Study Design Cross-sectional survey. Setting Online. Methods A survey was sent to all American Academy of Facial Plastic and Reconstructive Surgery FDs and co-FDs in September 2020. Descriptive analyses were performed. Results Of 77 eligible FDs, 45 responded (58.4%) representing a diverse group across the United States. All but 1 FD routinely screened patients for COVID-19 in the preoperative setting. FDs largely believed that universal preoperative testing was cost-effective (66.7%), improved patient safety (80.0%) and health care worker safety (95.6%), and was not burdensome for patients (53.3%). With regard to volume of cosmetic/aesthetic, reconstructive, facial nerve, and trauma surgery, FDs indicated largely no change in volume (34.9%, 71.0%, 68.4%, and 80.0%, respectively) or fellow experience (67.4%, 80.6%, 84.2%, and 80.0%). Half (50.0%) of the FDs reported decreased volume of congenital/craniofacial surgery, but 75.0% did not believe that there was a change in fellow experience. Overall, of the 15 responses indicating “worsened training” across all domains of FPRS, 14 were located in the Northeast (93.33%). Conclusions The COVID-19 pandemic has had the least impact on the volume of reconstructive procedures, facial nerve operations, and trauma surgery and a negative impact on congenital/craniofacial surgery volume, and it has accelerated the demand for cosmetic/aesthetic operations. Overall, the majority of FDs did not feel as though their fellows’ trainings would be adversely affected by the ongoing pandemic.

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