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Paciotti M, Diana P, Gallioli A, De Groote R, Farinha R, Ficarra V, Gaston R, Gontero P, Hurle R, Martínez-Piñeiro L, Minervini A, Pansadoro V, Van Cleynenbreugel B, Wiklund P, Casale P, Lughezzani G, Uleri A, Mottrie A, Palou J, Gallagher AG, Breda A, Buffi N. International consensus panel for transurethral resection of bladder tumours metrics: assessment of face and content validity. BJU Int 2024. [PMID: 38830818 DOI: 10.1111/bju.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To develop performance metrics that objectively define a reference approach to a transurethral resection of bladder tumours (TURBT) procedure, seek consensus on the performance metrics from a group of international experts. METHODS The characterisation of a reference approach to a TURBT procedure was performed by identifying phases and explicitly defined procedure events (i.e., steps, errors, and critical errors). An international panel of experienced urologists (i.e., Delphi panel) was then assembled to scrutinise the metrics using a modified Delphi process. Based on the panel's feedback, the proposed metrics could be edited, supplemented, or deleted. A voting process was conducted to establish the consensus level on the metrics. Consensus was defined as the panel majority (i.e., >80%) agreeing that the metric definitions were accurate and acceptable. The number of metric units before and after the Delphi meeting were presented. RESULTS A core metrics group (i.e., characterisation group) deconstructed the TURBT procedure. The reference case was identified as an elective TURBT on a male patient, diagnosed after full diagnostic evaluation with three or fewer bladder tumours of ≤3 cm. The characterisation group identified six procedure phases, 60 procedure steps, 43 errors, and 40 critical errors. The metrics were presented to the Delphi panel which included 15 experts from six countries. After the Delphi, six procedure phases, 63 procedure steps, 47 errors, and 41 critical errors were identified. The Delphi panel achieved a 100% consensus. CONCLUSION Performance metrics to characterise a reference approach to TURBT were developed and an international panel of experts reached 100% consensus on them. This consensus supports their face and content validity. The metrics can now be used for a proficiency-based progression training curriculum for TURBT.
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Affiliation(s)
- Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Rui Farinha
- Urology Department, Lusíadas Hospital, Lisbon, Portugal
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of Urology, University of Messina, Messina, Italy
| | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Paolo Gontero
- Department of Urology, University of Turin, Turin, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Luis Martínez-Piñeiro
- Department of Urology, La Paz University Hospital and La Paz Hospital Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Vito Pansadoro
- Fondazione Vincenzo Pansadoro, Centro di Urologia Laparoscopica e Oncologia Medica, Rome, Italy
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Uleri
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
- Orsi Academy, Melle, Belgium
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Anthony G Gallagher
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
- Orsi Academy, Melle, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Wu SC, Swanton AR, Jones JM, Gross MS. New findings regarding the influence of assistants on surgical outcomes in penile prosthesis implantation. Int J Impot Res 2023; 35:736-740. [PMID: 36209303 DOI: 10.1038/s41443-022-00624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation is the definitive treatment for refractory erectile dysfunction, yet exposure to this procedure during training of urology residents is often limited. To assess the effects of resident participation in penile prosthesis surgery, we compared surgical outcomes in a retrospective case series of 253 penile prosthesis surgeries by a single surgeon at the same institution between 2017 and 2020 with the assistance of either a registered nurse first assistant (RNFA) or a resident. Pertinent patient characteristics and surgical complications including device complications, surgical site infection, postoperative bleeding, iatrogenic injury, cardiovascular events, pulmonary events, and urinary retention were documented. Measured outcomes included operative time, Emergency Room (ER) visits, unplanned postoperative visits, pain medication refills, and surgical complications. Compared to RFNAs, resident-assisted penile prosthesis surgery was associated with significant increase in mean operative time (71.4 min vs. 87.9 min, p < 0.01) and postoperative ER visits (3.0% vs. 10.6%, p = 0.03) but not surgical complications (19.7% vs. 20.8%, OR 1.03, 95% CI [0.46 -2.30]) or other measured outcomes. Compared to a dedicated RFNA, Resident assistance increased operative time by approximately 17 min, but did not increase post-operative surgical complications, supporting the notion that resident assistance in these procedures may be appropriate as an integral part of training.
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Affiliation(s)
- Shuo-Chieh Wu
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Amanda R Swanton
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James M Jones
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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3
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Lyall V, Ould Ismail AA, Haggstrom DA, Issa MM, Siddiqui MM, Tosoian J, Schroeck FR. Accurate Documentation Contributes to Guideline-concordant Surveillance of Nonmuscle Invasive Bladder Cancer: A Multisite Department of Veterans Affairs Study. Urology 2023; 181:92-97. [PMID: 37660946 PMCID: PMC10901298 DOI: 10.1016/j.urology.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To determine if accurate documentation of bladder cancer risk was associated with a clinician surveillance recommendation that is concordant with AUA guidelines among patients with nonmuscle invasive bladder cancer (NMIBC). METHODS We prospectively collected data from cystoscopy encounter notes from four Department of Veterans Affairs (VA) sites to ascertain whether they included accurate documentation of bladder cancer risk and a recommendation for a guideline-concordant surveillance interval. Accurate documentation was a clinician-recorded risk classification matching a gold standard assigned by the research team. Clinician recommendations were guideline-concordant if the clinician recorded a surveillance interval that was in line with the AUA guideline. RESULTS Among 296 encounters, 75 were for low-, 98 for intermediate-, and 123 for high-risk NMIBC. 52% of encounters had accurate documentation of NMIBC risk. Accurate documentation of risk was less common among encounters for low-risk bladder cancer (36% vs 52% for intermediate- and 62% for high-risk, P < .05). Guideline-concordant surveillance recommendations were also less common in patients with low-risk bladder cancer (67% vs 89% for intermediate- and 94% for high-risk, P < .05). Accurate documentation was associated with a 29% and 15% increase in guideline-concordant surveillance recommendations for low- and intermediate-risk disease, respectively (P < .05). CONCLUSION Accurate risk documentation was associated with more guideline-concordant surveillance recommendations among low- and intermediate-risk patients. Implementation strategies facilitating assessment and documentation of risk may be useful to reduce overuse of surveillance in this group and to prevent unnecessary cost, anxiety, and procedural harms.
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Affiliation(s)
- Vikram Lyall
- White River Junction VA Healthcare System, White River Junction, VT; Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - David A Haggstrom
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Regenstrief Institute, & Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Muta M Issa
- Atlanta VA Medical Center & Emory University School of Medicine, Atlanta, GA
| | | | | | - Florian R Schroeck
- White River Junction VA Healthcare System, White River Junction, VT; Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH.
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4
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Nguyen AT, Anjaria DJ, Sadeghi-Nejad H. Advancing Urology Resident Surgical Autonomy. Curr Urol Rep 2023; 24:253-260. [PMID: 36917339 PMCID: PMC10011787 DOI: 10.1007/s11934-023-01152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE OF REVIEW This paper aims to survey current literature on urologic graduate medical education focusing on surgical autonomy. RECENT FINDINGS Affording appropriate levels of surgical autonomy has a key role in the education of urologic trainees and perceived preparedness for independent practice. Recent studies in surgical resident autonomy have demonstrated a reduction in autonomy for trainees in recent years. Efforts to advance the state of modern surgical training include creation of targeted curricula, enhanced with use of surgical simulation, and structured feedback. Decline in surgical autonomy for urology residents may influence confidence after completion of their residency. Further study is needed into the declining levels of urology resident autonomy, how it affects urologists entering independent practice, and what interventions can advance autonomy in modern urologic training.
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Affiliation(s)
- Anh T Nguyen
- Division of Urology Rutgers New Jersey Medical School, Newark, NJ, 07103, USA.
| | - Devashish J Anjaria
- East Orange Department of Surgery, Veteran Affairs New Jersey Healthcare System East Orange, East Orange, NJ, USA
| | - Hossein Sadeghi-Nejad
- East Orange Department of Surgery, Veteran Affairs New Jersey Healthcare System East Orange, East Orange, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
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5
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Foley J, Roesly H, Provo J, Henrie AM, Teramoto M, Cushman DM. Learning Effect for Large Joint Diagnostic Aspirations With Fluoroscopy and Ultrasound. Am J Phys Med Rehabil 2023; 102:444-448. [PMID: 36730909 DOI: 10.1097/phm.0000000000002134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The first objective was to identify whether increased experience, gauged by number of procedures performed posttraining, is correlated with greater likelihood of obtaining joint fluid in diagnostic aspirations. The second objective was to identify whether trainee involvement at the time of procedure affected the success rate of the procedure (which in this case was obtaining fluid on aspiration). DESIGN This was a retrospective analysis of fluoroscopic- and ultrasound-guided large joint aspirations. Logarithmic fit was performed to identify the presence of a learning curve to the successful attainment of fluid with experience. Logistic regression analysis was used to identify whether trainee presence for a procedure affected fluid attainment. RESULTS Ultrasound did not demonstrate a significant fit to the logarithmic curve ( P = 0.447), whereas fluoroscopy did ( P < 0.001), indicative of a learning curve for fluoroscopy. After adjusting for covariates, joint fluid was successfully attained at a similar rate whether trainees were present or not. Significant independent factors related to successful joint fluid attainment were image guidance technique ( P = 0.001), body mass index ( P = 0.032), and joint aspirated (overall P < 0.001). CONCLUSION There was a statistically significant learning curve for fluoroscopic-guided joint aspirations, but not with ultrasound guidance. Trainee involvement did not affect the success rate of joint aspirations.
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Affiliation(s)
- Justin Foley
- From the Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah (JF, JP, AMH, MT, DMC); Department of Emergency Medicine, University of Colorado, Denver, Colorado (HR); and Department of Orthopaedics, University of Utah, Salt Lake City, Utah (DMC)
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6
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Bube SH, Brix R, Christensen MB, Thostrup M, Grimstrup S, Hansen RB, Dahl C, Konge L, Azawi N. Surgical experience is predictive for bladder tumour resection quality. Scand J Urol 2022; 56:391-396. [PMID: 36065477 DOI: 10.1080/21681805.2022.2119271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle. METHODS A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT. RESULTS Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT. CONCLUSIONS It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.
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Affiliation(s)
- Sarah H Bube
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Brix
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | | | - Mathias Thostrup
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Søren Grimstrup
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Rikke B Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Claus Dahl
- Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,University of Copenhagen, Copenhagen, Denmark
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7
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Tsivian M, Bole R, Packiam VT, Boorjian SA, Thapa P, Frank I, Tollefson MK. The Association of Trainee Involvement in Radical Cystectomy With Perioperative and Oncologic Outcomes. Urology 2022; 165:128-133. [PMID: 35038487 DOI: 10.1016/j.urology.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/07/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the impact of trainee involvement in surgery on perioperative and oncological outcomes of patients undergoing radical cystectomy (RC). MATERIALS AND METHODS We reviewed the records of patients undergoing RC for urothelial carcinoma between 2000 and 2015 at our institution. Trainee level was categorized as fellow, chief, senior and junior residents. Demographic, perioperative and oncological outcomes were recorded and compared between the groups. Specifically, operative time, 30-day complications, severe complications (Clavien III-V) and oncological outcomes (overall, cancer-specific and recurrence-free survival) were assessed. RESULTS A total of 895 patients were included for study. On multivariable analysis, operative times were 30-40 minutes longer in procedures assisted by junior residents as compared to more senior trainees. Notably, trainee level was not associated with overall or severe complications on multivariable analyses. Similarly, trainee level was not associated with oncologic outcomes. CONCLUSION While cases assisted by junior residents had longer operative times, complication rates and oncological outcomes were comparable across trainee groups. Trainee level does not appear to have an impact on perioperative and oncological outcomes of RC for urothelial carcinoma.
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Affiliation(s)
| | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN.
| | | | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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8
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Bube SH, Kingo PS, Madsen MG, Vásquez JL, Norus T, Olsen RG, Dahl C, Hansen RB, Konge L, Azawi N. National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients. EUR UROL SUPPL 2022; 39:29-35. [PMID: 35528788 PMCID: PMC9068726 DOI: 10.1016/j.euros.2022.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/02/2022] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analyses Results and limitations Conclusions Patient summary
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9
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Bube SH, Kingo PS, Madsen MG, Vásquez JL, Norus TP, Olsen RG, Dahl C, Hansen RB, Konge L, Azawi NH. Validation of a novel assessment tool identifying proficiency in Transurethral Bladder Tumour Resection: The OSATURBS assessment tool. J Endourol 2021; 36:572-579. [PMID: 34731011 DOI: 10.1089/end.2021.0768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Competence in transurethral bladder tumour resection (TURB) is critical in bladder cancer management and should be ensured before independent practice. OBJECTIVE Develop an assessment tool for TURB and explore validity evidence in a clinical context. DESIGN, SETTING, AND PARTICIPANTS July 2019-March 2021, a total of 33 volunteer doctors from three hospitals were included. Participants performed two TURB procedures on patients with bladder tumours. A newly developed assessment tool (OSATURBS) was used for direct observation assessment, self-assessment, and blinded video-assessment. Outcome measurements and statistical analysis: Cronbach's alpha and Pearson's r were calculated for across items internal consistency reliability, inter-rater reliability, and test-retest reliability. Correlation between OSATURBS scores and the operative experience was calculated with Pearson's r and a pass/fail score was established. Differences in assessment scores were explored with paired t-test and independent samples t-test. RESULTS AND LIMITATIONS The internal consistency reliability across items Cronbach's alpha was 0.94 (n = 260, p < 0.001). Inter-rater reliability = 0.80 (n = 64, p < 0.001). Test-retest correlation was high, r = 0.71 (n = 32, p < 0.001). Relation to TURB experience was high, r = 0.71 (n = 32, p < 0.001). Pass/fail score = 19 points. Direct observation assessments were strongly correlated with video ratings (r = 0.85, p < 0.001) but with a significant social bias with lower scores for inexperienced and higher scores for experienced participants. Participants tended to overestimate their own performances. CONCLUSIONS OSATURBS assessment tool for TURB can be used for assessment of surgical proficiency in the clinical setting. Direct observation assessment and self-assessment are biased, and blinded video-assessment of TURB performances is advised.
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Affiliation(s)
- Sarah Hjartbro Bube
- Zealand University Hospital Roskilde, 53140, Department of Urology, Roskilde, Zealand, Denmark.,University of Copenhagen, 4321, Faculty of Health and Medical Science, Copenhagen, Denmark;
| | | | - Mia Gebauer Madsen
- Aarhus Universitetshospital, 11297, Department of Urology, Aarhus, Denmark;
| | - Juan Luis Vásquez
- Zealand University Hospital Roskilde, 53140, Department of Urology, Roskilde, Zealand, Denmark.,University of Copenhagen, 4321, Faculty of Health and Medical Science, Copenhagen, Zealand, Denmark;
| | - Thomas Peter Norus
- Zealand University Hospital Roskilde, 53140, Department of Urology, Roskilde, Sjaelland, Denmark;
| | - Rikke Groth Olsen
- National Hospital of the Faroe Islands, 112892, Surgical Department, Torshavn, Faroe Islands.,Rigshospitalet, 53146, CAMES - Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark;
| | - Claus Dahl
- Capio Ramsay Santé, Department of Urology, Hellerup, Denmark;
| | - Rikke Bølling Hansen
- Herlev Hospital, 53176, Department of Urology, Gentofte, Denmark.,Rigshospitalet, 53146, CAMES - Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark;
| | - Lars Konge
- Rigshospitalet, 53146, CAMES - Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.,University of Copenhagen, 4321, Faculty of Health and Medical Science, Copenhagen, Denmark;
| | - Nessn H Azawi
- Zealand University Hospital Roskilde, 53140, Department of Urology, Roskilde, Zealand, Denmark.,University of Copenhagen, 4321, Faculty of Health and Medical Science, Copenhagen, Denmark;
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10
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Schuettfort VM, Pradere B, Compérat E, Abufaraj M, Shariat SF. Novel transurethral resection technologies and training modalities in the management of nonmuscle invasive bladder cancer: a comprehensive review. Curr Opin Urol 2021; 31:324-331. [PMID: 33973535 DOI: 10.1097/mou.0000000000000892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Conventional transurethral resection (TURBT) with tumor fragmentation is the primary step in the surgical treatment of nonmuscle invasive bladder cancer. Recently, new surgical techniques and training modalities have emerged with the aim to overcome short-comings of TURBT and improve oncologic outcomes. In this review, we provide a comprehensive update of recent techniques/techniques that aim to improve upon conventional TURBT and beyond. RECENT FINDINGS A systemic approach during conventional TURBT that features the use of a surgical checklist has been shown to improve recurrence-free survival. Several simulators have been developed and validated to provide additional training opportunities. However, transfer of improved simulator performance into real world surgery still requires validation. While there is no convincing data that demonstrate superior outcomes with bipolar TURBT, en-bloc resection already promises to offer lower rates of complications as well as potentially lower recurrence probabilities in select patients. SUMMARY TURBT remains the quintessential procedure for the diagnosis and treatment of bladder cancer. Urologists need to be aware of the importance and challenges of this procedure. Aside of embracing new resection techniques and a conceptual-systematic approach, training opportunities should be expanded upon to improve patient outcomes.
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Affiliation(s)
- Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Eva Compérat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- European Association of Urology Research Foundation, Arnhem, The Netherlands
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Roumiguié M, Xylinas E, Brisuda A, Burger M, Mostafid H, Colombel M, Babjuk M, Palou Redorta J, Witjes F, Malavaud B. Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours. Cancers (Basel) 2020; 12:cancers12103063. [PMID: 33092240 PMCID: PMC7589904 DOI: 10.3390/cancers12103063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Transurethral resection of bladder tumours may be technically challenging. Complexity was defined by consensus from the literature by a panel of ten senior urologists as “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Patient and tumour’s characteristics that suggested to by the panel to relate to complex surgery were collected and then ranked by Delphi consensus. They were tested in the prediction of complexity in 150 clinical scenarios. After univariate and logistic regression analyses, significant characteristics were organized into a checklist that predicts complexity. Receiver operating characteristics (ROC) curves of the regression model and the corresponding calibration curve showed adequate discrimination (AUC = 0.916) and good calibration. The resulting Bladder Complexity Checklist can be used to deliver optimal preoperative information and personalise the organisation of surgery. Abstract Ten senior urologists were interrogated to develop a predictive model based on factors from which they could anticipate complex transurethral resection of bladder tumours (TURBT). Complexity was defined by consensus. Panel members then used a five-point Likert scale to grade those factors that, in their opinion, drove complexity. Consensual factors were highlighted through two Delphi rounds. Respective contributions to complexity were quantitated by the median values of their scores. Multivariate analysis with complexity as a dependent variable tested their independence in clinical scenarios obtained by random allocation of the factors. The consensus definition of complexity was “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 h) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Logistic regression highlighted five domains as independent predictors: patient’s history, tumour number, location, and size and access to the bladder. Receiver operating characteristic (ROC) analysis confirmed good discrimination (AUC = 0.92). The sum of the scores of the five domains adjusted to their regression coefficients or Bladder Complexity Score yielded comparable performance (AUC = 0.91, C-statistics, p = 0.94) and good calibration. As a whole, preoperative factors identified by expert judgement were organized to quantitate the risk of a complex TURBT, a crucial requisite to personalise patient information, adapt human and technical resources to individual situations and address TURBT variability in clinical trials.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
| | | | - Antonin Brisuda
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | - Maximillian Burger
- St. Josef, Klinik für Urologie, Caritas-Krankenhaus, 93053 Regensburg, Germany;
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Surrey, Guildford GU2 7RF, UK;
| | - Marc Colombel
- Department of Urology, Hôpital Edouard Herriot, 69437 Lyon, France;
| | - Marek Babjuk
- Department of Urology, 2nd Faculty of Medicine, Charles University, Teaching Hospital Motol, 15006 Prague, Czech Republic; (A.B.); (M.B.)
| | | | - Fred Witjes
- Department of Urology, Radboud UMC, 6525 GA Nijmegen, The Netherlands;
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer, 31059 Toulouse CEDEX 9, France;
- Correspondence:
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12
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Kinio A, Ramsay T, Jetty P, Nagpal S. Declining institutional memory of open abdominal aortic aneurysm repair. J Vasc Surg 2020; 73:889-895. [PMID: 32712346 DOI: 10.1016/j.jvs.2020.06.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Since its introduction, endovascular aneurysm repair (EVAR) has become a mainstay in the treatment of abdominal aortic aneurysms (AAAs), resulting in the decline of open aneurysm repairs. The objective of this study was to determine whether reduced open aneurysm repair frequency has led to a reduction in perioperative efficiency and increase in postsurgical complications. METHODS A retrospective cohort study compared perioperative data and complications of 49 consecutive juxtarenal AAA (<1-cm neck) open repairs performed between 2014 and 2017 and 53 consecutive juxtarenal AAA controls (2005-2007) at The Ottawa Hospital. There was no change in surgical personnel during this 10-year comparison. RESULTS The Ottawa Hospital experienced a 61% decline in the number of open AAA repairs between the two time periods examined; 541 open AAA repairs and 86 EVARs were performed between 2005 and 2007, whereas 358 open AAA repairs and 385 EVARs were performed between 2014 and 2017. Age of participants significantly decreased in the 2014 to 2017 group (P = .01), as did the number of women undergoing open juxtarenal AAA repair (P = .05). Total operating room time and anesthesia time were longer in the 2014-2017 group (P = .02; P = .01), whereas surgical times remained consistent (P = .13). Suprarenal clamp time and blood loss during the procedure were decreased in the 2014-2017 group (P < .01; P < .01). Intensive care unit stay and overall hospital stay were not significantly different between groups (P = .77; P = .87); however, there were large standard deviations observed for the 2014-2017 group. As well, 18.4% of patients in the 2014-2017 group experienced postsurgical complications of Clavien-Dindo grade IIIa or higher compared with 11.3% of patients in the historical control group (P = .07). Mortality also trended toward an increase in the 2014-2017 group (P = .43). CONCLUSIONS The reduced rate of open repair performance at The Ottawa Hospital reflects the global trend toward EVAR. Anesthesia and operating room times increased during the period examined, reflecting a possible loss of expertise in the last decade. Complications also increased during this time for anatomically similar patients. Taken together, these findings may reflect a decreased institutional familiarity with open aneurysm repair and postsurgical care.
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Affiliation(s)
- Anna Kinio
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Prasad Jetty
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sudhir Nagpal
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Poletajew S, Krajewski W, Kaczmarek K, Kopczyński B, Stamirowski R, Tukiendorf A, Zdrojowy R, Słojewski M, Radziszewski P. The Learning Curve for Transurethral Resection of Bladder Tumour: How Many is Enough to be Independent, Safe and Effective Surgeon? JOURNAL OF SURGICAL EDUCATION 2020; 77:978-985. [PMID: 32147466 DOI: 10.1016/j.jsurg.2020.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/03/2020] [Accepted: 02/15/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Transurethral resection of the bladder tumour (TURBT) is one the most common urological procedures. It is also one the fundamental surgeries performed by residents. The learning curve (LC) for TUR has never been analysed. The aim of the study was to analyse the learning curve of TURBT in a residency setting. DESIGN, SETTING AND PARTICIPANTS This retrospective multicentre analysis of prospectively maintained databases enrolled 993 consecutive TURBTs performed by 10 urology residents in 3 academic institutions. Study end-points were as follows: the absence of muscularis propria in a specimen, any intra- or postoperative surgical complication and 3-month recurrence-free survival. RESULTS With increasing experience, residents operated more complex cases defined by higher rate of large, multifocal or high-risk tumours. In the same time, surgery time, postoperative catheterization time and hospital stay became shorter. An improvement has been noticed regarding the muscularis propria sampling and 3-month recurrence-free survival, but not regarding the risk of surgical complications. Evident improvement in study end-points was noticed after 101 operations; surgeons achieved the best clinical outcomes after performing 170 procedures, whereas the poorest results for the first 45 operations. CONCLUSIONS TURBT has a flat LC with 100 cases being the absolute minimum for a resident in training to achieve acceptable oncological and surgical outcomes.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland.
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Bartłomiej Kopczyński
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Remigiusz Stamirowski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | | | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
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14
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Yip W, Vij SC, Li J, Samplaski MK. The effect of trainee involvement on surgical outcomes and complications of male infertility surgical procedures. Andrologia 2020; 52:e13719. [PMID: 32557781 DOI: 10.1111/and.13719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
In this study, we sought to determine the effect of trainee (resident or fellow physician) involvement in male infertility surgical procedures on patient surgical outcomes and complications. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed for fertility surgical procedures from 2006 to 2012. The procedures included were as follows: epididymectomy, spermatocelectomy, varicocelectomy ± hernia repair, ejaculatory duct resection, vasovasostomy, vasoepididymostomy and 'unlisted procedure male genital system' (to capture sperm retrieval procedures). A variety of peri- and post-operative outcomes were examined. Trainee and nontrainee-involved groups were compared by Wilcoxon rank sum tests, followed by logistic regression, univariate and multivariate analyses. 924 cases were included: 309 with trainees and 615 without. The median post-graduate trainee year was 3 (range: 0-10). Patients in the trainee-involved cohort had higher rates of chronic obstructive pulmonary disease, steroid usage and black race. Mean operative time was 42.5% longer in trainee-involved cases, even after controlling for other covariates (76.2 vs. 49.5 min, p = .00). Hospital stay length was also longer in trainee-involved cases (0.41 vs. 0.35 days, p = .02). There were no differences in superficial infections (p = 1.00), deep wound infections (p = 1.00), urinary tract infections (p = .26), or reoperations (p = .23) with or without trainee involvement.
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Affiliation(s)
- Wesley Yip
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
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Resident Trainees Increase Surgical Time: A Comparison of Obstetric and Gynaecologic Procedures in Academic Versus Community Hospitals. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:430-438.e2. [DOI: 10.1016/j.jogc.2019.08.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022]
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Bube S, Dagnaes-Hansen J, Mahmood O, Rohrsted M, Bjerrum F, Salling L, Hansen RB, Konge L. Simulation-based training for flexible cystoscopy – A randomized trial comparing two approaches. Heliyon 2020; 6:e03086. [PMID: 31922043 PMCID: PMC6948262 DOI: 10.1016/j.heliyon.2019.e03086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/29/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023] Open
Abstract
Background Simulation-based training allows trainees to experiment during training and end-of-training tests could increase motivation and retention. The aim of this trial was to determine if a simulation-based training program including directed self-regulated learning and post-testing improved clinical outcomes compared to a traditional simulation-based training program. Methods A randomized trial was conducted involving 32 participants without prior experience in endoscopic procedures. The intervention group practiced independently in a simulation centre and got a post-test whereas the control group received traditional instructions and demonstrations before being allowed to practice. Three weeks after the intervention the participants performed cystoscopies on two consecutive patients. Clinical performance was assessed using a global rating scale (GRS) with established evidence of validity. Independent samples t-test, Cronbach's α, Pearson's r, and paired samples t-test were used for statistical analysis. Results Twenty-five participants performed two cystoscopies on patients. There was no significant difference between the two study groups with respect to mean GRS of performance (p = 0.63, 95 % CI; -2.4–3.9). The internal consistency of the global rating scale was high, Cronbach's α = 0.91. Participants from both study groups demonstrated significant improvement between the first and second clinical procedures (p = 0.004, 95 % CI, 0.8–3.5). Eight (32%) and 15 (60%) participants demonstrated adequate clinical skills in their first and second procedure, respectively. Conclusions No significant differences were found on the clinical transfer when comparing the two programs. Neither of our training programs was able to ensure consistent, competent performance on patients and this finding could serve as an important argument for simulation-based mastery learning where all training continues until a pre-defined level of proficiency is met. Trial registrations The trial was submitted before enrolment of participants to the Regional Scientific Ethics Committee of the Capital Region which established that ethical approval was not necessary (H-4-2014-122). The trial was registered at Clinicaltrials.gov (NCT02411747).
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Affiliation(s)
- Sarah Bube
- Department of Urology, Roskilde Hospital, Zealand University Hospital, University of Copenhagen, Zealand Region, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Corresponding author.
| | - Julia Dagnaes-Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Anaesthesiology, Holbaek Hospital, Zealand Region, Holbaek, Denmark
| | - Malene Rohrsted
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Surgery, Herlev/Gentofte Hospital, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Lisbeth Salling
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Rikke B. Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Urology, Herlev/Gentofte Hospital, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
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Chen A, Ghodoussipour S, Titus MB, Nguyen JH, Chen J, Ma R, Hung AJ. Comparison of clinical outcomes and automated performance metrics in robot-assisted radical prostatectomy with and without trainee involvement. World J Urol 2019; 38:1615-1621. [PMID: 31728671 DOI: 10.1007/s00345-019-03010-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In this study, we investigate the effect of trainee involvement on surgical performance, as measured by automated performance metrics (APMs), and outcomes after robot-assisted radical prostatectomy (RARP). METHODS We compared APMs (instrument tracking, EndoWrist® articulation, and system events data) and clinical outcomes for cases with varying resident involvement. Four of 12 standardized RARP steps were designated critical ("cardinal") steps. Comparison 1: cases where the attending surgeon performed all four cardinal steps (Group A) and cases where a trainee was involved in at least one cardinal step (Group B). Comparison 2, where Group A is split into Groups C and D: cases where attending performs the whole case (Group C) vs. cases where a trainee performed at least one non-cardinal step (Group D). Mann-Whitney U and Chi-squared tests were used for comparisons. RESULTS Comparison 1 showed significant differences in APM profiles including camera movement time, third instrument usage, dominant instrument moving time, velocity, articulation, as well as non-dominant instrument moving time and articulation (all favoring Group A p < 0.05). There was a significant difference in re-admission rates (10.9% in Group A vs 0% in Group B, p < 0.02), but not for post-operative outcomes. Comparison 2 demonstrated a significant difference in dominant instrument articulation (p < 0.05) but not in post-operative outcomes. CONCLUSIONS Trainee involvement in RARP is safe. The degree of trainee involvement does not significantly affect major clinical outcomes. APM profiles are less efficient when trainees perform at least one cardinal step but not during non-cardinal steps.
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Affiliation(s)
- Andrew Chen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Saum Ghodoussipour
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Micha B Titus
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Jessica H Nguyen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Jian Chen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Runzhuo Ma
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Andrew J Hung
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA.
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Bube SH, Hansen RB, Dahl C, Konge L, Azawi N. Development and validation of a simulator-based test in transurethral resection of bladder tumours (TURBEST). Scand J Urol 2019; 53:319-324. [DOI: 10.1080/21681805.2019.1663921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Sarah Hjartbro Bube
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Boelling Hansen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Urology, Herlev/Gentofte Hospital, Herlev, Denmark
| | - Claus Dahl
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
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Baber J, Staff I, McLaughlin T, Tortora J, Champagne A, Gangakhedkar A, Pinto K, Wagner J. Impact of Urology Resident Involvement on intraoperative, Long-Term Oncologic and Functional Outcomes of Robotic Assisted Laparoscopic Radical Prostatectomy. Urology 2019; 132:43-48. [PMID: 31228477 DOI: 10.1016/j.urology.2019.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the impact of resident involvement in robot assisted laparoscopic prostatectomy on oncologic, functional, and intraoperative outcomes, both short and long term. METHODS We queried our prospectively maintained database of prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy from November 20, 2007 to December 27, 2016. We analyzed cases performed by 1 surgeon on a specific day of the week when the morning case involved at least 1 resident (R) and the afternoon case involved the attending physician only (nonresident [NR]). We compared R versus NR on a number of clinical, perioperative, and oncological outcomes. RESULTS A total of 230 NR and 230 R cases met inclusion criteria and were included in the analysis. Over one third (36.7%) of the NR group was Gleason 4+3 (Grade Group 3) or higher, relative to 25.9% of the R group, P = .015. Median operative time (OT) was significantly longer for R versus NR (200 minutes versus 156 minutes, P<.001) as was robotic time (161 minutes versus119 minutes, P<.001). No significant differences were noted for any other measure. Median follow-up for oncological outcomes was 30 and 33.5 months for NR and R, respectively (P= .3). Median OT and median estimated blood loss were both significantly greater in later years relative to the earlier years for R (2012-2016 versus 2007-2011; P< .001 for OT; P= .041 for median estimated blood loss) but not for NR. CONCLUSION Neither safety nor quality is diminished by R involvement in robot assisted laparoscopic prostatectomy.
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Affiliation(s)
- Jacob Baber
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Alison Champagne
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Akshay Gangakhedkar
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
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Holland BC, Patel N, Sulaver R, Stevenson B, Healey J, Severino W, Baron T, Lieber D, Roszhart D, McVary KT, Köhler TS. Resident Impact on Patient & Surgeon Satisfaction and Outcomes: Evidence for Health System Support for Urology Education. Urology 2019; 132:49-55. [PMID: 31195011 DOI: 10.1016/j.urology.2019.04.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the effect of resident involvement on patient and physician satisfaction, we evaluated the outcomes from a private urology group both prior to and after initiation of resident coverage. METHODS Urologic procedures completed by attending surgeons without residents from October 2010 to December 2011 were compared to the same surgeons working with residents from January 2012 to March 2013. Surgical case times, postoperative complications, readmission rate, length of stay, Press-Ganey consumer assessments, resident and physician self-report of training quality and quality of life were collected. RESULTS 3316 operative and nonoperative cases were measured.Total 1565 were in preresident periods and 1751 were in postresident periods. With resident coverage, there was an increase in OR times. There was no difference in complications for surgical and nonsurgical cases (P = .2269 and P = 1.000, respectively). There was a statistically significant improvement of readmission rate in nonsurgical patients with resident coverage (P = .0344). Patients' satisfaction scores were higher in every category and they more often reported that they "always" received quality care (78.6 % vs 82.5%) with resident coverage. Resident and faculty perceptions of training, patient care, and satisfaction increased with resident coverage. CONCLUSION Resident coverage of a private practice urology group resulted in no difference in surgical complications and improvement in readmission rates in nonsurgical patients. It resulted in longer OR times but greater satisfaction of faculty, residents and most important, patients. Our data demonstrate the beneficial effect of resident participation in patient care and provides further justification of residency financial support.
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Affiliation(s)
- Bradley C Holland
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL.
| | - Neil Patel
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL
| | | | | | - Jessica Healey
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL
| | | | | | | | | | - Kevin T McVary
- Southern Illinois University School of Medicine, Division of Urology, Springfield, IL
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21
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Pereira JF, Pareek G, Mueller-Leonhard C, Zhang Z, Amin A, Mega A, Tucci C, Golijanin D, Gershman B. The Perioperative Morbidity of Transurethral Resection of Bladder Tumor: Implications for Quality Improvement. Urology 2019; 125:131-137. [DOI: 10.1016/j.urology.2018.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/07/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022]
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22
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de Vries AH, Muijtjens AMM, van Genugten HGJ, Hendrikx AJM, Koldewijn EL, Schout BMA, van der Vleuten CPM, Wagner C, Tjiam IM, van Merriënboer JJG. Development and validation of the TOCO–TURBT tool: a summative assessment tool that measures surgical competency in transurethral resection of bladder tumour. Surg Endosc 2018; 32:4923-4931. [DOI: 10.1007/s00464-018-6251-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
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23
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Brady JS, Crippen MM, Filimonov A, Nadpara NV, Eloy JA, Baredes S, Park RCW. The effect of training level on complications after free flap surgery of the head and neck. Am J Otolaryngol 2017; 38:560-564. [PMID: 28716300 DOI: 10.1016/j.amjoto.2017.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/02/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Analyze postoperative complications after free flap surgery based on PGY training level. METHODS Data on free flap surgeries of the head and neck performed from 2005 to 2013 was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cases identifying the status of resident participation in the surgery and the PGY level were included. RESULTS There were 582 cases with primary surgeon data available. 63 cases were performed with a junior resident, 211 were performed with the assistance of a senior resident, 279 cases were performed with a fellow, and 29 cases were performed by an attending alone without resident involvement. The overall complication rate was 55.2%. There was no statistically significant difference in the rate of complications between groups (47.6%, 59.7%, 53.0%, 58.6%, p=0.277). After controlling for all confounding variables using multivariate analysis there was no significant difference in morbidity, mortality, readmissions, and reoperation amongst the groups. Furthermore, when comparing resident versus fellow involvement using multivariate analysis there were no significant differences in morbidity (OR=0.768[0.522-1.129]), mortality (OR=1.489[0.341-6.499]), readmissions (OR=1.018[0.458-2.262]), and reoperation (OR=0.863[0.446-1.670]). CONCLUSION Resident and fellow participation in microvascular reconstructive cases does not appear to increase 30-day rates of medical, surgical, or overall complications.
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Affiliation(s)
- Jacob S Brady
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Meghan M Crippen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Andrey Filimonov
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neil V Nadpara
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
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Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity. Surg Endosc 2017; 32:702-711. [PMID: 28726138 DOI: 10.1007/s00464-017-5726-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 07/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical trainee association with operative outcomes is controversial. Studies are conflicting, possibly due to insufficient control of confounding variables such as operative time, case complexity, and heterogeneous patient populations. As operative complications worsen long-term outcomes in oncologic patients, understanding effect of trainee involvement during laparoscopic colectomy for cancer is of utmost importance. Here, we hypothesized that resident involvement was associated with worsened 30-day mortality and 30-day overall morbidity in this patient population. METHODS Patients undergoing laparoscopic colectomy for oncologic diagnosis from 2005 to 2012 were assessed using the American College of Surgeons National Surgical Quality Improvement Program dataset. Propensity score matching accounted for demographics, comorbidities, case complexity, and operative time. Attending only cases were compared to junior, middle, chief resident, and fellow level cohorts to assess primary outcomes of 30-day mortality and 30-day overall morbidity. RESULTS A total of 13,211 patients met inclusion criteria, with 4075 (30.8%) cases lacking trainee involvement and 9136 (69.2%) involving a trainee. Following propensity matching, junior (PGY 1-2) and middle level (PGY 3-4) resident involvement was not associated with worsened outcomes. Chief (PGY 5) resident involvement was associated with worsened 30-day overall morbidity (15.5 vs. 18.6%, p = 0.01). Fellow (PGY > 5) involvement was associated with worsened 30-day overall morbidity (16.0 vs. 21.0%, p < 0.001), serious morbidity (9.3 vs. 13.5%, p < 0.001), minor morbidity (9.8 vs. 13.1%, p = 0.002), and surgical site infection (7.9 vs. 10.5%, p = 0.006). No differences were seen in 30-day mortality for any resident level. CONCLUSION Following propensity-matched analysis of cancer patients undergoing laparoscopic colectomy, chief residents, and fellows were associated with worsened operative outcomes compared to attending along cases, while junior and mid-level resident outcomes were no different. Further study is necessary to determine what effect the PGY surgical trainee level has on post-operative morbidity in cancer patients undergoing laparoscopic colectomy in the context of multiple collinear factors.
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Prasad NNG, Muddukrishna SN. Quality of transurethral resection of bladder tumor procedure influenced a phase III trial comparing the effect of KLH and mitomycin C. Trials 2017; 18:123. [PMID: 28292319 PMCID: PMC5351261 DOI: 10.1186/s13063-017-1843-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/16/2017] [Indexed: 11/12/2022] Open
Abstract
Background Retrospective analysis of Center effect of the multi-center trial conducted to compare Immucothel (KLH Immunotherapy drug product) with Mytomycin-C (MM) concluded that efficacy evaluation of the drug product may be impacted by physician’s subjective performance of Transurethral resection of bladder tumor (TURBT). Methods A randomized trial was performed in 18 hospitals (clinical centers) and a total of 553 recruited, 283 patients under KLH arm and 270 patients under MM. An initial statistical analysis of efficacy comparisons between KLH and MM based on log-rank test performed for each center (hospital) showed 6 hospitals out of 18 hospitals a p-value of <0.05 and remaining 12 hospitals showed a p-values of >0.05. No association was observed between number of patients analysed and the associated p-values across hospitals. Final statistical analyses were carried out under each drug product using Kaplan-Meier survival analysis along with log-rank test after combining all eligible patients data for 6 hospital group and 12 hospital group. Results Median recurrence free survival (RFS) times (in weeks) showed statistical significance (p-value = 0.03) between two groups of hospitals under KLH arm, while similar median values showed no statistical significance (p-value = 0.05). Conclusion Center effect with respect to median RFS values under KLH was more pronounced than under MM. Under the presence of such center effect, for reasons other than product related effects, concluding superiority of one drug product over another may create confounding bias conclusions in multi-center clinical trials. In the above cited clinical trial study, physician’s prior experience on TURBT might have contributed to center effect in examining efficacies of KLH and MM. Similar observation was also noted in the literature on studies dealing with TURBT and in other clinical studies. Trial registration Data set used in this study is based on previously documented clinical trial in the literature: See (Lammers et al., J Clin Oncol 30:2273–9, 2012) and Acknowledgments. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1843-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Narasimha N G Prasad
- Department of Mathematical and Statistical Sciences, University of Alberta, T6G 2G1, Edmonton, AB, Canada.
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Folsom C, Serbousek K, Lydiatt W, Rieke K, Sayles H, Smith R, Panwar A. Impact of resident training on operative time and safety in hemithyroidectomy. Head Neck 2017; 39:1212-1217. [DOI: 10.1002/hed.24742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/08/2016] [Accepted: 01/03/2017] [Indexed: 01/28/2023] Open
Affiliation(s)
- Craig Folsom
- Department of Otolaryngology - Head and Neck Surgery; Naval Medical Center Portsmouth; Portsmouth Virginia
| | - Kimberly Serbousek
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | - William Lydiatt
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
| | - Katherine Rieke
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Harlan Sayles
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Russell Smith
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
| | - Aru Panwar
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery; University of Nebraska Medical Center; Omaha Nebraska
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
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Does Trainee Involvement in Fluoroscopic Injections Affect Fluoroscopic Time, Immediate Pain Reduction, and Complication Rate? PM R 2017; 9:1013-1019. [PMID: 28093372 DOI: 10.1016/j.pmrj.2016.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/30/2016] [Accepted: 12/23/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients have expressed concern about undergoing procedures involving trainees, even with direct attending physician supervision. Little literature has examined the effect of trainee involvement on patient outcomes. OBJECTIVE We aimed to evaluate the effect of trainee involvement on patient complications, immediate pain reduction, and fluoroscopic time for different fluoroscopic injection types. DESIGN Retrospective review. SETTING Four academic outpatient institutions with Accreditation Council for Graduate Medical Education (ACGME)-accredited residency (physical medicine and rehabilitation, or anesthesiology) or fellowship (sports medicine or pain medicine) programs from 2000 to 2015. PATIENTS All patients receiving fluoroscopically guided hip (HI), sacroiliac joint (SIJI), transforaminal epidural (TFEI), and/or interlaminar epidural injections (ILEI, performed at only 1 institution). METHODS Outcome measures were examined based on the presence or absence of a trainee during the procedure. MAIN OUTCOME MEASUREMENTS The primary outcome was the number of immediate complications, with secondary outcomes being fluoroscopic time per injection (FTPI) and immediate numeric rating scale percentage improvement. RESULTS Trainees were involved in 67.0% of all injections (N = 7,833). Complication rates or improvements in numeric rating scale scores showed no significant differences with trainee involvement for any injection type (P > .05). Trainee involvement was associated with increased FTPI for ILEIs (18.2 ± 10.1 seconds with trainees versus 15.1 ± 8.5 seconds without trainees, P < .001), but not for HIs (P = .60) or SIJIs (P = .51). Trainee involvement with TFEIs was dependent on institution for outcome with respect to FTPI (P < .001), with 28.1 ± 17.9 seconds with trainees and 32.1 ± 22.1 seconds without trainees (P = 0.51). CONCLUSIONS This large multicenter study of academic institutions demonstrates that trainee involvement in fluoroscopically guided injections does not affect immediate patient complications or pain improvement. Trainee involvement does not increase fluoroscopic time for most injections, although there is an institutional difference seen. This study supports the notion that appropriate trainee supervision likely does not compromise patient safety for fluoroscopically guided injections. LEVEL OF EVIDENCE II.
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Welk B, Winick-Ng J, McClure A, Vinden C, Dave S, Pautler S. The impact of teaching on the duration of common urological operations. Can Urol Assoc J 2016; 10:172-178. [PMID: 27713793 DOI: 10.5489/cuaj.3737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals. METHODS We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002-2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume. RESULTS 114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10-21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres. CONCLUSIONS Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.
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Affiliation(s)
- Blayne Welk
- University of Western Ontario, London, ON, Canada;; Institute for Clinical Evaluative Sciences, London, ON, Canada
| | | | - Andrew McClure
- Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Chris Vinden
- University of Western Ontario, London, ON, Canada;; Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Sumit Dave
- University of Western Ontario, London, ON, Canada
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The Effect of Resident Involvement on Surgical Outcomes for Common Urologic Procedures: A Case Study of Uni- and Bilateral Hydrocele Repair. Urology 2016; 94:70-6. [DOI: 10.1016/j.urology.2016.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 11/18/2022]
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Bos D, Allard CB, Dason S, Ruzhynsky V, Kapoor A, Shayegan B. Impact of resident involvement in endoscopic bladder cancer surgery on pathological outcomes. Scand J Urol 2016; 50:234-8. [PMID: 27045233 DOI: 10.3109/21681805.2016.1163616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Transurethral resection of bladder tumor (TURBT) pathology specimens which lack muscle are associated with clinical upstaging and may necessitate repeat resections, potentially delaying curative treatment. This study evaluated whether resident involvement in TURBT is associated with suboptimal perioperative outcomes. MATERIALS AND METHODS All TURBTs performed at a Canadian healthcare institution from November 2011 to June 2014 were reviewed. Multivariable logistic regression models assessed associations between intraoperative resident involvement and TURBT muscle presence. Among high-risk patients (high grade, ≥ T1 or carcinoma in situ) who underwent cystectomy, time from TURBT to cystectomy was compared between resident and attending urologists with the log-rank test. RESULTS In total, 463 TURBTs were identified. In multivariable analyses, residents were less likely to obtain muscle in specimens for all TURBTs [adjusted odds ratio (aOR) 0.59, p = 0.03] and the subset of 275 high-risk TURBTs (aOR 0.41, p = 0.006). Among patients who underwent cystectomy, time to cystectomy was delayed by a median of 23 days when residents were involved in the initial high-risk TURBT compared with attending urologists only (p = 0.024). CONCLUSIONS In this single academic center series, intraoperative resident involvement was associated with a decreased rate of muscle presence in TURBT specimens and a prolonged time to cystectomy.
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Affiliation(s)
- Derek Bos
- a McMaster University , Hamilton , ON , Canada
| | - Christopher B Allard
- a McMaster University , Hamilton , ON , Canada ;,b Massachusetts General Hospital , Boston , MA , USA ;,c Brigham and Women's Hospital , Boston , MA , USA
| | - Shawn Dason
- a McMaster University , Hamilton , ON , Canada
| | | | - Anil Kapoor
- a McMaster University , Hamilton , ON , Canada
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Meyer CP, Salem J, Kluth LA, Sanatgar N, Borgmann H, Grange P, Chun F. Das GeSRU Endo-Training – Strategien zur Optimierung der endourologischen Ausbildung. Urologe A 2015; 55:253-6. [DOI: 10.1007/s00120-015-0015-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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