Measuring quality for robot-assisted radical cystectomy worldwide: External validation of the quality cystectomy score utilizing the international robotic cystectomy consortium

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Conference Proceeding

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Can Urol Assoc J


Introduction: Ensuring quality and comprehensive patient care is a duty of modern surgical practice. To optimize care for patients undergoing cystectomy, our group developed best practices for patients undergoing robot-assisted radical cystectomy (RARC) - Quality Cystectomy Score (QCS). In this study, we sought to validate the QCS and its effect on survival utilizing the International Robotic Cystectomy Consortium (IRCC) database. Methods: Retrospective review of IRCC database (23 institutions from 12 countries) was performed. QCS is a composite measure of surgical performance based on four sets of quality metrics (I- preoperative criteria [administration of neoadjuvant chemotherapy]; II-operative criteria [overall operative time (<6.5 hours) and estimated blood loss <500 ml]; III-pathological criteria [negative soft tissue surgical margins and lymph node yield of >20]; and IV-perioperative criteria [no Clavien- Dindo Grade III-IV complications, readmission, or mortality within 30-d]). QCS was used to evaluate surgical performance and Kaplan-Meier method was used to compute relationship to oncological outcomes (recurrence-free survival [RFS], diseasespecific survival [DSS], and overall survival [OS] rates]. Cox proportional hazards model was fit to evaluate predictors of survival Results: 1412 patients were included. Mean age was 67 years; 41% had extravesical and 22% were node-positive; 20% received NAC. Improvements in all the individual domains were observed except the perioperative domain, which was high and did not change. 86% received at least three stars and the proportion of patients receiving four stars increased from 8% in 2006 to 40% in 2016. Patients who had higher QCS star score showed better RFS, DSS, and OS (log rank p<0.001). On multivariable Cox proportional hazards analysis, patients who had lower QCS scores were more likely to have worse RFS (odds ratio [OR] 1.32; 95% confidence interval [CI] 1.01-1.92; p=0.04), DSS (OR 1.59; 95% CI 1.05-2.40; p=0.03), and OS (OR 1.69; 95% CI 1.27-2.25; p=0.004). Conclusions: QCS was a significant predictor of RFS, DSS, and OS and was able to measure the quality of surgical care worldwide. QCS can be measured to monitor programs and guide remediation.





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