Technical Skill of Partial Nephrectomy on Patient Outcomes: A Video Review Project

Document Type

Conference Proceeding

Publication Date

9-1-2023

Publication Title

J Endourol

Abstract

Introduction: It is unknown if technical skills of surgeons performing robotic partial nephrectomy (RPN) are linked to patient outcomes. We conducted a peer surgeon video review exercise in a surgical collaborative to understand if aspects of the procedure could be identified for improving patient outcomes. Methods: RPN surgeons participating in a statewide quality improvement collaborative (MUSIC-KIDNEY) were invited to submit and review RPN videos. Videos were segmented into 6 steps: exposure of kidney, identification of ureter and gonadal, hilar dissection, tumor localization, clamping and resection, and renorrhaphy. Video clips were deidentified and distributed to blinded peer reviewer surgeons who provided written feedback and scores using a previously published evaluation tool: Scoring for Partial Nephrectomy (SPaN), 1 = lowest and 5 = highest. Outcomes from MUSIC registry for all submitting surgeons were assessed for length of stay (LOS), estimated blood loss (EBL) > 500, warm ischemia time (WIT) > 30 min, positive surgical margin (PSM), and readmission. Surgeons were stratified into low scoring (score ≤ median score) and high scoring (score > median). Outcomes were compared between cohorts through Chi squared and Fisher's exact test with p-value < 0.05. Score card and written comments were provided to all participants. Participant survey results were collected 2 months after video review. Results: 11 surgeons submitted a total of 127 video clips; 379 total reviews were performed by 24 reviewers over the span of 2 months. The average score for reviewed clips was 4.1, with surgeon averages ranging between 3.6 and 4.7. Low-scores overall as well as in tumor resection and renorrhaphy were significantly associated with several outcomes including PSM, 30 day readmissions, EBL, and LOS (Figure). Surveys indicated submitters and reviewers found the process and score card valuable for identifying areas of improvement, learning different RPN techniques, and educating trainees. Conclusions: Video review of RPN demonstrated that surgeons with higher technical skill had a significantly lower frequency of intraoperative and post-operative complications. Given these results, the MUSIC- KIDNEY collaborative are in the process of developing interventions to address technical aspects of RPN with the goal to reassess and improve outcomes.

Volume

37

First Page

A160

Last Page

A161

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