195 Validity of an institutional preceptor education program for surgeon training and quality control of surgical outcomes during robot-assisted radical prostatectomy

Introduction: Today’s surgical practice has evolved, with increasing emphasis on quality assurance. Many forms of quality-control monitoring have been suggested, but they are often impractical or difficult to implement. Cumulative summation (CUSUM) is a simple method to provide visual feedback before significant quality issues arise. We present our initial use and practical application of CUSUM in a surgical practice. Methods: A retrospective analysis was applied to a prospectively collected database of 577 sequential patients who have undergone robot-assisted radical prostatectomy from a single surgeon over a 10-year period. Outcome measures were analyzed with CUSUM, which included a composite complication score, continence rates, length of hospital stay, biochemical recurrence, and need for adjuvant radiation. If any outcomes were out of control, they would cross the CUSUM failure line. Results: CUSUM chart-plotting for incontinence demonstrated an initial upward slope followed by trending to a new safety limit. Additionally, outcomes in complications and biochemical recurrence did not reach the established safety boundaries. Length of stay and radiation outcomes did initially cross the safety line, but were improved over time. Conclusions: The use of CUSUM in clinical practice can fulfill the need for quality assurance. CUSUM plotting in our practice reflected the initial learning curve, followed by ongoing maintenance and improvement in performance. These changes were consistent with the implementation of changes in surgical techniques. Although this tool was used retrospectively, this strengthens our argument to implement the tool prospectively and assess real-time refinement of surgeon skill. We have demonstrated that CUSUM can be appropriately used to assure quality control in a surgical practice.

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Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Comparative Analysis of the Surgical Outcomes in a Single Regional Center

Current Urology ◽

10.1159/000447192 ◽

2017 ◽

Vol 11 (1) ◽

pp. 36-41 ◽

Cited By ~ 16

Author(s):

Lorenzo Giuseppe Luciani ◽

Daniele Mattevi ◽

William Mantovani ◽

Tommaso Cai ◽

Stefano Chiodini ◽

...

Keyword(s):

Radical Prostatectomy ◽

Hospital Stay ◽

Surgical Outcomes ◽

Complication Rates ◽

Robot Assisted ◽

Operative Outcomes ◽

Regional Center ◽

Lower Blood ◽

Continence Rate ◽

Laparoscopic Assisted

Background: To compare the surgical outcomes of radical prostatectomy (RP) performed via 3 different approaches: retropubic (RRP), laparoscopic-assisted (LRP), and robot-assisted (RARP), in a single non-academic regional center by a single surgeon. Materials and Methods: The data of patients undergoing RP from 2005 to 2014 were reviewed. The standard approach changed through the years: RRP (n = 380, years 2005 to 2008), LRP (n = 240, years 2009 to 2011), and RARP (n = 262, years 2012 to 2014). Our analysis included the last consecutive 100 RP for each surgical technique by a single surgeon. A logistic regression model adjusted for pre-and postoperative variables was done to evaluate whether transfusion, conversion, and post-operative complication rates were influenced by the approach. Results: RARP was associated with significantly lower blood loss (400 vs. 600 and 600 ml, respectively), transfusion (6 vs. 21 and 21%, respectively), and shorter hospital stay (6 vs. 7 and 8 days, respectively), compared to LRP and RRP, and a lower conversion rate (1 vs. 12%) compared to LRP. Multivariate analysis adjusted for confounders confirmed that the risk of transfusion and conversion was significantly lower in the RARP group compared to the LRP and RRP groups. The RARP group was also associated with a significantly lower risk of complications compared to the RRP group and with a trend in favor of the RARP group compared to the LRP group. The 1-year continence rate was significantly higher in the RARP group compared to the RRP and LRP groups (80 vs. 72 and 68%, respectively). Conclusion: The surgical approach affected the operative outcomes in a regional setting. The advantages of RARP over RRP (complications, transfusion, conversion, hospital stay, 1-year continence) were over LRP as well, with the only exception being complications.

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