Researchers validate robotic cystectomy quality tool

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A team from Roswell Park Cancer Institute has developed and validated a quality assessment tool based on prospectively collected data on robot-assisted cystectomy.

In an effort to effectively measure quality of care and share best practices in surgical oncology, a team from Roswell Park Cancer Institute in Buffalo, NY developed a quality assessment tool and validated it in a study based on 10 years of prospectively collected data on robot-assisted cystectomies.

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The study, published in Urology (2016; 97:124-9), revealed that centers that thoroughly track all aspects of care will better predict patient outcomes and improve patient care for those having their bladders removed.

“We’ve been seeing over the years that quality is becoming the primary driver for everything. A lot of things in bladder cancer didn’t depend on just the surgery, and the surgeon was just one piece of the puzzle. It’s really about the whole package,” lead author Khurshid Guru, MD, of Roswell Park Cancer Institute, told Urology Times. “It’s important to also consider disease severity, comorbidities, and other potentially modifiable aspects of care when evaluating surgical performance for a complex disease such as bladder cancer.”

Dr. Guru and his colleagues developed a measurement tool called the Quality Cystectomy Score (QCS) with the idea of predicting long-term outcomes.

The authors looked at 425 patients who underwent robot-assisted surgery between the 10-year period of 2005-2015 and rated each patient’s clinical outcome on a four-star scale that took into account demographics as well as everything from pre-op to post-op care. Factors including whether the surgery finished on time, whether a medical oncologist was consulted, the amount of blood loss, and what the complications of surgery were are considered in the score.

“We wanted to measure all these indicators so it would tell us how we’re doing. For any new procedure, I think it’s ideal to take metrics and make a dashboard,” Dr. Guru said. “A standardized quality-measurement approach such as the one we created and validated can help provider teams to assess their performance and can also identify areas for improvement, making this tool a valuable resource for patients, their families, and providers as they make important health care decisions.”

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The study showed that 85% of patients achieved at least three stars, and an even higher number achieved four stars over time.

Patients with four stars achieved a recurrence-free survival rate of 62%, cancer-specific survival of 70%, and overall survival at 5 years of 53%. Meanwhile, none of those with one star were alive after 1 year.

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“Patients who were assigned three or four stars had better recurrence-free, cancer-specific, and overall survival. That’s the most important thing,” Dr. Guru said. “Anyone can come up with a scoring system, but at the end of day, the scoring system needs to be correlated with survival.

“If you get a patient rated at four stars, it reflects a very good performance at every step and by the whole team, not just the surgeon. That’s what makes this scoring system very unique.”

Since the study was first published online, the response from the medical community has been very favorable, especially with a decade’s worth of data available.

“Every physician or anyone involved in health care, really, cares about providing quality patient care, and if this scoring card helps us get there more objectively, I think it is a good resource to have,” Dr. Guru said. “Our findings show the benefit of applying stringent standards for assessing surgical outcomes and of tracking data continuously and comprehensively.”