Ahmed Aly Hussein Aly

Citation:

Hussein, A. A., S. Dibaj, N. Hinata, E. Field, K. O'leary, B. Kuvshinoff, J. L. Mohler, G. Wilding, and K. A. Guru, "Development and Validation of a Quality Assurance Score for Robot-Assisted Radical Cystectomy: a 10-Year Analysis.", Urology, 2016 Aug 1.

Abstract:

OBJECTIVE: To develop quality assessment tool to evaluate surgical performance for robot-assisted radical cystectomy (RARC) program.

METHODS: A prospectively maintained quality assurance database of 425 consecutive RARCs performed by a single surgeon between 2005 and 2015 was retrospectively reviewed. Potentially modifiable factors, related to the management and perioperative care of patients were used to evaluate patient care. Criteria included: Preoperative (administration of neoadjuvant chemotherapy); Operative (operative time <6.5 hours and estimated blood loss <500cc); Pathologic (negative soft tissue surgical margins and lymph node yield ≥20); and Postoperative (no high grade complications, readmission or non-cancer related mortality within 30 d).The Quality Cystectomy Score (QCS) was developed (1 star: achieving ≤2 criteria or mortality within 30 d; 2 stars: 3 or 4 criteria met; and 3 stars: 5 or 6 criteria met; 4 stars: 7 or all criteria met). Univariate and multivariate Cox proportional hazard regression models were fitted to test for the association between QCS and survival outcomes.

RESULTS: Most patients (85%) achieved at least 3 stars, and more patients achieved 4 stars with time. High QCS was associated with better recurrence free (RFS), cancer specific (CSS) and overall survival (OS) (p-values <0.05). None of the patients with 1-star were alive at 1 yr. Patients with 4 stars achieved the best survival rates (RFS 62%, CSS 70% and OS 53% at 5 yrs) (log rank p<0.0001).

CONCLUSION: Continuous assessment for quality improvement facilitated implementation and maintenance of robot-assisted program for bladder cancer.

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