The impact of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy

Shane M. Pearce, Joseph J Pariser, Sanjay G. Patel, Blake B. Anderson, Scott E. Eggener, Gregory P. Zagaja

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To examine the effect of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy (RALP). Methods: We analyzed a single-surgeon series of 2036 RALP cases between 2003 and 2014. Days between cases (DBC) was calculated as the number of days elapsed since the surgeon’s previous RALP with the second start cases assigned 0 DBC. Surgeon experience was assessed by dividing sequential case experience into cases 0–99, cases 100–249, cases 250–999, and cases 1000+ based on previously reported learning curve data for RALP. Outcomes included estimated blood loss (EBL), operative time (OT), and positive surgical margins (PSMs). Multiple linear regression was used to assess the impact of the DBC and surgeon experience on EBL, OT, and PSM, while controlling for patient characteristics, surgical technique, and pathologic variables. Results: Overall median DBC was 1 day (0–3) and declined with increasing surgeon case experience. Multiple linear regression demonstrated that each additional DBC was independently associated with increased EBL [β = 3.7, 95 % CI (1.3–6.2), p < 0.01] and OT [β = 2.3 (1.4–3.2), p < 0.01], but was not associated with rate of PSM [β = 0.004 (−0.003–0.010), p = 0.2]. Increased experience was also associated with reductions in EBL and OT (p < 0.01). Surgeon experience of 1000+ cases was associated with a 10 % reduction in PSM rate (p = 0.03) compared to cases 0–99. Conclusions: In a large single-surgeon RALP series, DBC was associated with increased blood loss and operative time, but not associated with positive surgical margins, when controlling for surgeon experience.

Original languageEnglish (US)
Pages (from-to)269-274
Number of pages6
JournalWorld Journal of Urology
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Robotics
Prostatectomy
Operative Time
Linear Models
Learning Curve
Surgeons
Margins of Excision

Keywords

  • Outcomes
  • Prostatectomy
  • Prostatic neoplasm
  • Skill depreciation
  • Surgeon volume

Cite this

The impact of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy. / Pearce, Shane M.; Pariser, Joseph J; Patel, Sanjay G.; Anderson, Blake B.; Eggener, Scott E.; Zagaja, Gregory P.

In: World Journal of Urology, Vol. 34, No. 2, 01.02.2016, p. 269-274.

Research output: Contribution to journalArticle

Pearce, Shane M. ; Pariser, Joseph J ; Patel, Sanjay G. ; Anderson, Blake B. ; Eggener, Scott E. ; Zagaja, Gregory P. / The impact of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy. In: World Journal of Urology. 2016 ; Vol. 34, No. 2. pp. 269-274.
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abstract = "Purpose: To examine the effect of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy (RALP). Methods: We analyzed a single-surgeon series of 2036 RALP cases between 2003 and 2014. Days between cases (DBC) was calculated as the number of days elapsed since the surgeon’s previous RALP with the second start cases assigned 0 DBC. Surgeon experience was assessed by dividing sequential case experience into cases 0–99, cases 100–249, cases 250–999, and cases 1000+ based on previously reported learning curve data for RALP. Outcomes included estimated blood loss (EBL), operative time (OT), and positive surgical margins (PSMs). Multiple linear regression was used to assess the impact of the DBC and surgeon experience on EBL, OT, and PSM, while controlling for patient characteristics, surgical technique, and pathologic variables. Results: Overall median DBC was 1 day (0–3) and declined with increasing surgeon case experience. Multiple linear regression demonstrated that each additional DBC was independently associated with increased EBL [β = 3.7, 95 {\%} CI (1.3–6.2), p < 0.01] and OT [β = 2.3 (1.4–3.2), p < 0.01], but was not associated with rate of PSM [β = 0.004 (−0.003–0.010), p = 0.2]. Increased experience was also associated with reductions in EBL and OT (p < 0.01). Surgeon experience of 1000+ cases was associated with a 10 {\%} reduction in PSM rate (p = 0.03) compared to cases 0–99. Conclusions: In a large single-surgeon RALP series, DBC was associated with increased blood loss and operative time, but not associated with positive surgical margins, when controlling for surgeon experience.",
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AU - Zagaja, Gregory P.

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KW - Prostatic neoplasm

KW - Skill depreciation

KW - Surgeon volume

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