@article {116590, title = {Development and Validation of a Quality Assurance Score for Robot-Assisted Radical Cystectomy: a 10-Year Analysis.}, journal = {Urology}, year = {2016}, note = {n/a}, month = {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.

}, issn = {1527-9995}, doi = {10.1016/j.urology.2016.06.063}, author = {Hussein, Ahmed A and Dibaj, Shiva and Hinata, Nobuyuki and Field, Erinn and O{\textquoteright}leary, Kathleen and Kuvshinoff, Boris and Mohler, James L and Wilding, Gregory and Guru, Khurshid A} }