CUA 2018: Incorporating Measures of Patient Safety into Technical Skill Assessments in Robotic Assisted Radical Prostatectomy

Halifax, Nova Scotia ( Recently, the emergence of surgical skill assessment has drastically influenced patient care within urological practice. However, common skill assessments have often focused on measuring technical ability alone, as intraoperative error and technical events have not been utilized in these evaluations. Alaina Garbens, MD, of the University of Toronto believed that these particular metrics may have predictive properties when evaluating surgical skills for robot-assisted radical prostatectomy (RARP). In this particular study, Dr. Garbens hoped to elucidate the urologic community on the distribution of errors and events in RARP, the association between performance scores and safety metrics, and the relationship between safety metrics and outcomes. 
In this particular study, intraoperative video from prospective RARP cases were collected following surgery, then all patient identifiable data was In this particular study, intraoperative video from prospective RARP cases were collected following surgery, thenstripped from the videos and given to experts to review. These expert analysts used three separate grading scales to rate the videos: Global Evaluative Assessment of Robotic Skills (GEARS), the Generic Error Rating Tool (GERT), and the Prostatectomy Assessment of Competency Evaluation (PACE). The three grading scales are beneficial in their own right, as being focused more towards surgeon skills, safety, or technique, respectively. 

At the completion of the study, 91 RARP cases were captured by 11 staff surgeons and 19 residents/fellows. There were no significant differences in preoperative patient characteristics between the two groups. Using Spearman’s Rho coefficient, GEARS adverse events, PACE adverse events, and technical errors were found to be 0.337, 0.238, and 0.289, respectively. Additionally, it was found that total errors have a direct correlation to patient length of stay in the hospital postoperatively, as a bivariate analysis between 1-day inpatients versus ≥ 2 day inpatients showed that the ≥ 2-day arm had significantly higher total errors from the procedure. 

This was the first study to describe associations between perioperative adverse events and technical performance in RARP. In her closing remarks, Dr. Garbens admitted there was a modest correlation between performance assessments and safety metrics. 

Presented by Alaina Garbens, MD, University of Toronto

Written by Zachary Valley, Twitter: @ZacharyAValley, Department of Urology, University of California-Irvine at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia