Presentation Authors: Mitchell Goldenberg*, Alaina Garbens, Hossein Sadaat, Antonio Finelli, Rajiv Singal, Jason Lee, Teodor Grantcharov, Toronto, Canada
Introduction: Objective assessments of surgical technical performance have been identified as a novel measure of surgical quality across multiple procedures. This study aimed to investigate the ability of such assessments to predict clinically significant patient outcomes following robotic-assisted radical prostatectomy, in a multi-centre, prospective cohort.
Methods: Surgical video from patients undergoing robotic-assisted radical prostatectomy at three institutions was collected over a nine-month period. Blinded surgical analysts were completed assessments of surgeon technical skill using the Global Evaluative Assessment of Robotic Skills (GEARS), and the Prostatectomy Assessment Competency Evaluation (PACE). Postoperative urinary continence at three months, sexual function at 12-months, and positive surgical margins were selected as primary outcomes. Binary logistic regression was used to control for patient factors, and a sensitivity analysis was carried out to account for surgeon and hospital fixed effects. Cross-validation was carried out to further test the predictive models.
Results: 31 surgeons, including staff and trainees, and 92 patients were eligible in the final analysis. Level of training and previous case experience were associated with higher performance scores at key operative steps. On multivariable analysis, overall GEARS score was an independent predictor of continence (p < .05), and PACE score was independently predictive of continence (p < .01), potency (p < .05), and positive surgical margin (p < .05). After including surgeon experience and hospital volume in these models, only PACE remained a significant predictor of continence (p < .01) and positive surgical margin (p = .02). Cross validation reduced the areas under the curve for the continence model from 0.742-0.740, and the positive surgical margin model from 0.725-0.521.
Conclusions: Surgical technical skill is a predictor of oncological and functional outcomes following robotic-assisted radical prostatectomy. These findings have implications for training, credentialing, and quality improvement in the field of urologic oncology.
Source of Funding: Royal College of Physicians and Surgeons of Canada (RCPSC)Canadian Urologic Oncology Group (CUOG)