AUA 2017: Best Abstract - Technical Skill Assessment of Surgeons Performing Robot-Assisted Radical Prostatectomy: Relationship Between Crowdsourced Review and Patient Outcomes

Boston, MA ( Surgical performance is under increasing scrutiny from multiple stakeholders and efforts to develop systematic ways to objectively assess surgeon skills are ultimately aimed at improving patient care for the benefit of greater healthcare system. Pilot work from Michigan Urological Surgery Improvement Collaborative (MUSIC) showed that crowdsourced video ratings of skill for surgeons performing robot-assisted radical prostatectomy (RARP) have strong correlation with peer surgeon ratings. In this study, Dr. Ghani and colleagues aim to assess the association between crowd review of surgeon skill with patient outcomes following RARP.

Surgeons in MUSIC: 43 practices, including 260 urologists, submitted representative video of a nerve-sparing RARP. Edited video clips of urethrovesical anastomosis were assessed using Global Evaluative Assessment of Robotic Skills (GEARS) via C-SATS Inc (Seattle, WA), by crowdworkers. A mean GEARS score for each video clip was derived using a linear mixed effects model and surgeons were ranked on their skill score and sorted into quartiles of skill. Risk-adjusted perioperative complication rates in the patient level between surgeons (n=7) in the lowest skill quartile were compared to surgeons (n=8) in the highest quartile, using data from a prospective registry with 2,256 patients. Odds ratios (OR) were calculated and likelihood ratio tests were used to assess statistical difference between quartiles.

Crowdworkers (n=285) gave 867 video ratings on anastomosis procedures from 29 MUSIC surgeons within 4 hours. Crowd ratings for global robotic skill ranged from 16.5 to 18.0 in the lowest quartile, and from 20.2 to 21.9 in the highest quartile. Compared to surgeons in the lowest quartile, surgeons in the highest quartile had significantly lower rates of urethral catheter replacement and readmission rates after RARP, but not lower rates of excess blood loss.

From the results, the authors conclude that crowdsourced assessments of technical skills for practicing robotic surgeons performing the anastomosis varied widely, and correlated with clinically relevant post-surgical outcomes for RARP. They suggest that in the future, the technical ability of a surgeon may become a significant performance measurement directly linked to patient outcomes.

Presented By: Khurshid Ghani, MD, MS

Authors: Khurshid R. Ghani, Ann Arbor, MI, Bryan Comstock, Seattle, WA, David C. Miller, Rodney L. Dunn, Tae Kim, Susan Linsell, Ann Arbor, MI, Brian R. Lane, Grand Rapids, MI, Richard Sarle, Dearborn, MI, Thomas Lendvay, Seattle, WA, James Montie, Ann Arbor, MI, James O. Peabody, Detroit, MI

Affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI

Written By: Susan Li, Department of Urology, School of Medicine, University of California, Irvine, for

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA