Surgical checklist adherence across urology expertise levels impacts transurethral resection of bladder tumour quality indicators
Por:
Del Giudice, F, D'Andrea, D, Pradere, B, Berndl, F, Pallauf, M, Flammia, RS, Philipp, D, Moschini, M, Mari, A, Albisinni, S, Krajewski, W, Laukhtina, E, Gallioli, A, Mertens, LS, Marcq, G, Cimadamore, A, Afferi, L, Gontero, P, Shariat, SF, Chung, BI, Soria, F
Publicada:
1 jun 2023
Ahead of Print:
1 nov 2022
Resumen:
Objectives To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumour (TURBT) accuracy and oncological outcomes in non-muscle-invasive bladder cancer. Patients and Methods We relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardised peri-procedural nine-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS). Results A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 (29.6%) and by residents in 89 (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.03-2.99, P = 0.04). Conversely, no differences in DM presence were seen between young vs expert consultants (OR 1.09, 95% CI 0.71-1.70, P = 0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts' counterparts (56% and 56% vs 44%, P = 0.009). When focusing on patients receiving a second-look TURBT, the persistent disease was associated with resident status (OR 4.24, 95% CI 1.14-17.70, P = 0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS. Conclusion Surgeon's experience in the case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at re-TURBT, although no 5-year RFS differences were noted.
Filiaciones:
Del Giudice, F:
Sapienza Univ Rome, Policlin Umberto I Hosp, Dept Maternal Infant & Urol Sci, Rome, Italy
Stanford Univ, Sch Med, Dept Urol, Stanford, CA 94305 USA
D'Andrea, D:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Pradere, B:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
La Croix Sud Hosp, Dept Urol, Quint Fonsegrives, France
Berndl, F:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Pallauf, M:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Flammia, RS:
Sapienza Univ Rome, Policlin Umberto I Hosp, Dept Maternal Infant & Urol Sci, Rome, Italy
Philipp, D:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Moschini, M:
Osped San Raffaele, Dept Urol, Milan, Italy
Sci Inst, Milan, Italy
Mari, A:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy
Albisinni, S:
Univ Libre Bruxelles, Erasme Hosp, Urol Dept, Brussels, Belgium
Krajewski, W:
Wroclaw Med Univ, Dept Urol & Oncol Urol, Wroclaw, Poland
Laukhtina, E:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Gallioli, A:
Fundacio Puigvert, Urol, Barcelona, Spain
Mertens, LS:
Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
Marcq, G:
CHU Lille, Claude Huriez Hosp, Urol Dept, Lille, France
Univ Lille, Inst Pasteur Lille, UMR9020 U1277,CNRS, CHU Lille,INSERM,CANTHER Canc Heterogene Plast &, Lille, France
Cimadamore, A:
Polytech Univ Marche Reg, United Hosp, Sch Med, Sect Pathol Anat, Ancona, Italy
Afferi, L:
Luzerner Kantonsspital, Dept Urol, Luzern, Switzerland
Gontero, P:
Univ Torino, Dept Surg Sci, Urol Div, Turin, Italy
Shariat, SF:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Weill Cornell Med Coll, Dept Urol, New York, NY USA
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
Al Ahliyya Amman Univ, Hourani Ctr Appl Sci Res, Amman, Jordan
Chung, BI:
Stanford Univ, Sch Med, Dept Urol, Stanford, CA 94305 USA
Soria, F:
Univ Torino, Dept Surg Sci, Urol Div, Turin, Italy
hybrid, All Open Access; Hybrid Gold
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