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- Title
Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy.
- Authors
Wang, Yuzhi; Wilder, Samantha; Hijazi, Mahmoud; Myles, Marquisha D.; Mirza, Mahin; Van Til, Monica; Maatman, Thomas; Ghani, Khurshid R.; Lane, Brian R.; Rogers, Craig G.
- Abstract
Key Points: Question: Is surgeon technical skill associated with perioperative outcomes for robot-assisted partial nephrectomy? Findings: In this quality improvement study that included peer assessments of surgical skill for 10 urological surgeons, higher technical skill was associated with lower rates of extended hospital stay, high estimated blood loss, positive surgical margins, 30-day emergency department visits, and 30-day readmissions. Higher annual partial nephrectomy volume was associated with higher technical skill. Meaning: These findings suggest that video-based evaluation plays a beneficial role in assessing surgical skill and should be considered in quality improvement initiatives to improve patient care. This quality improvement study assesses whether surgeon scores representing technical skills of robot-assisted kidney surgery are associated with patient outcomes. Importance: Technical skill in complex surgical procedures may affect clinical outcomes, and there is growing interest in understanding the clinical implications of surgeon proficiency levels. Objectives: To determine whether surgeon scores representing technical skills of robot-assisted kidney surgery are associated with patient outcomes. Design, Setting, and Participants: This quality improvement study included 10 urological surgeons participating in a surgical collaborative in Michigan from July 2021 to September 2022. Each surgeon submitted up to 7 videos of themselves performing robot-assisted partial nephrectomy. Videos were segmented into 6 key steps, yielding 127 video clips for analysis. Each video clip was deidentified and distributed to at least 3 of the 24 blinded peer surgeons from the collaborative who also perform robot-assisted partial nephrectomy. Reviewers rated technical skill and provided written feedback. Statistical analysis was performed from May 2023 to January 2024. Main Outcomes and Measures: Reviewers scored each video clip using a validated instrument to assess technical skill for partial nephrectomy on a scale of 1 to 5 (higher scores indicating greater skill). For all submitting surgeons, outcomes from a clinical registry were assessed for length of stay (LOS) greater than 3 days, estimated blood loss (EBL) greater than 500 mL, warm ischemia time (WIT) greater than 30 minutes, positive surgical margin (PSM), 30-day emergency department (ED) visits, and 30-day readmission. Results: Among the 27 unique surgeons who participated in this study as reviewers and/or individuals performing the procedures, 3 (11%) were female, and the median age was 47 (IQR, 39-52) years. Risk-adjusted outcomes were associated with scores representing surgeon skills. The overall performance score ranged from 3.5 to 4.7 points with a mean (SD) of 4.1 (0.4) points. Greater skill was correlated with significantly lower rates of LOS greater than 3 days (−6.8% [95% CI, −8.3% to −5.2%]), EBL greater than 500 mL (−2.6% [95% CI, −3.0% to −2.1%]), PSM (−8.2% [95% CI, −9.2% to −7.2%]), ED visits (−3.9% [95% CI, −5.0% to −2.8%]), and readmissions (−5.7% [95% CI, −6.9% to −4.6%]) (P <.001 for all). Higher overall score was also associated with higher partial nephrectomy volume (β coefficient, 11.4 [95% CI, 10.0-12.7]; P <.001). Conclusions and Relevance: In this quality improvement study on video-based evaluation of robot-assisted partial nephrectomy, higher technical skill was associated with lower rates of adverse clinical outcomes. These findings suggest that video-based evaluation plays a role in assessing surgical skill and can be used in quality improvement initiatives to improve patient care.
- Subjects
MICHIGAN; SURGICAL robots; KIDNEY tumors; RESEARCH funding; ISCHEMIA; CRONBACH'S alpha; BLOOD loss estimation; PATIENT readmissions; LOGISTIC regression analysis; NEPHRECTOMY; TREATMENT effectiveness; DESCRIPTIVE statistics; HOSPITAL emergency services; CLINICAL competence; QUALITY assurance; LENGTH of stay in hospitals; CONFIDENCE intervals; DATA analysis software; PERIOPERATIVE care
- Publication
JAMA Network Open, 2024, Vol 7, Issue 7, pe2421696
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.21696