Development and Validation of a Quality Assurance Score for Robot-Assisted Radical Cystectomy: a 10-Year Analysis

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

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.

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).

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

Urology. 2016 Aug 01 [Epub ahead of print]

Ahmed A Hussein, Shiva Dibaj, Nobuyuki Hinata, Erinn Field, Kathleen O'leary, Boris Kuvshinoff, James L Mohler, Gregory Wilding, Khurshid A Guru

Department of Urology, Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, Cairo University, Egypt., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY., Department of Urology, Kobe University, Japan., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY., Department of Anesthesia, Roswell Park Cancer Institute., Department of Surgical Oncology, Roswell Park Cancer Institute., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY., Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: .

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe