Surgical checklist adherence across urology expertise levels impacts transurethral resection of bladder tumour quality indicators
Language English Country England, Great Britain Media print-electronic
Document type Journal Article
PubMed
36251366
DOI
10.1111/bju.15920
Knihovny.cz E-resources
- Keywords
- #BladderCancer, #blcsm, #uroonc, bladder cancer, non-muscle-invasive bladder cancer, resident, surgical experience, transurethral resection of bladder tumour,
- MeSH
- Cystectomy MeSH
- Checklist MeSH
- Humans MeSH
- Urinary Bladder Neoplasms * surgery pathology MeSH
- Prospective Studies MeSH
- Transurethral Resection of Bladder MeSH
- Quality Indicators, Health Care MeSH
- Urology * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
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.
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology and Oncological Urology Wrocław Medical University Wrocław Poland
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology La Croix du Sud Hospital Quint Fonsegrives France
Department of Urology Luzerner Kantonsspital Luzern Switzerland
Department of Urology San Raffaele Hospital and Scientific Institute Milan Italy
Department of Urology Stanford University School of Medicine Stanford CA USA
Department of Urology The Netherlands Cancer Institute Amsterdam The Netherlands
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Urology Department Claude Huriez Hospital CHU Lille Lille France
Urology Department Erasme Hospital Université Libre de Bruxelles Brussels Belgium
Urology Division Department of Surgical Sciences University of Studies of Torino Turin Italy
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