AUA 2019: Impact of Implementation of Standardized Criteria in the Assessment of Complication Reporting after Robotic Partial Nephrectomy

Chicago, IL ( Methodic measuring and reporting of postoperative outcomes and complications is necessary to ensure safety and quality of care, particularly in an era of evidence-based medicine. Despite a clear need for a rigorous system, surgical complication definitions and reporting still lack standardization, hampering evaluation of surgical performance. The early (2002), Martin system, was qualitative and possessed challenges associated with this methodology. The Clavien-Dindo system was developed shortly after in 2004, and was quantitative in nature, excluding a qualitative component. In 2012, the European Association of Urology (EAU) proposed a standardized reporting tool that incorporates both qualitative and quantitative systems into a reporting schema. The aim of this study is to evaluate the impact of these recommendations for patients who have undergone robotic partial nephrectomy (RPN).

A comprehensive systematic review of publications was performed using online databases. Quality of reporting and grading complications were assessed according to EAU recommendations.

They identified 1093 RPN publications including 114 case series and 155 comparitive studies. 208 (77%) were published after 2012. The majority of papers (86%) reported complications as outcomes of interest. Over time there was an improvement in outcome reporting in terms of mortality and its causes (11% versus 24%, p=0.05), definitions of complications (33% versus 52%, p<0.001), severity complication grade (42% versus 92%, p<0.001), and risk factors (23% versus 46%, p<0.001). The study results do not indicate prevalence of specific reporting methods (e.g. Clavien-Dindo, EAU, etc.).

In conclusion, the authors suppose that EAU recommendations on complication reporting may have had a positive impact on outcome measurement and reporting after RPN. Reporting of intraoperative outcomes is still lacking and warrants attention. Discussions from the audience included proposals for journals to require standardized reporting in publications.

Presented by: Giovanni E. Cacciamani, MD, Assistant Professor of Research Urology Keck School of Medicine of USC, Los Angeles, CA 

Authors: Luis Medina, Tania Gill, Alessandro Tafuri, Willy Baccaglini, Felipe glina, Vanessa Blasic, Matthew Winter, Akbar Ashrafi, Andre De Castro Abreu, Rene Sotelo, Inderbir Gill, Los Angeles, CA, Walter Artibani, Verona, Italy 

Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois