Impact Of Surgical Case Order On Perioperative Outcomes For Robotic-Assisted Radical Prostatectomy

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment (1)1 Apr 2013888 IMPACT OF SURGICAL CASE ORDER ON PERIOPERATIVE OUTCOMES FOR ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Anil Thomas, Armen Derboghossians, Allen Chang, David Finley, Jeff Slezak, Brian Kim, Steven Jacobsen, and Gary Chien Anil ThomasAnil Thomas Los Angeles, CA More articles by this author , Armen DerboghossiansArmen Derboghossians Los Angeles, CA More articles by this author , Allen ChangAllen Chang Los Angeles, CA More articles by this author , David FinleyDavid Finley Los Angeles, CA More articles by this author , Jeff SlezakJeff Slezak Los Angeles, CA More articles by this author , Brian KimBrian Kim Los Angeles, CA More articles by this author , Steven JacobsenSteven Jacobsen Los Angeles, CA More articles by this author , and Gary ChienGary Chien Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since its introduction, there have been many refinements in the technique and implementation of robotic-assisted radical prostatectomy (RARP). However it is unclear whether operative outcomes are influenced by surgical case order. We evaluated the effect of case order on perioperative outcomes for RARP within a large health maintenance organization. METHODS We conducted a retrospective review of RARP cases performed at our institution from September 2008 until December 2010 using a single robotic platform. Case order was determined from surgical schedules each day and surgeries were grouped into 1st, 2nd, and 3rd round cases. Fourth round cases (n=1) were excluded from analysis. We compared clinicopathological variables including operative time, estimated blood loss, surgical margin rates, and complication rates between groups. RESULTS Of the 1018 RARP cases in this cohort, 476 (47%) were performed as 1st round cases, 398 (39%) 2nd round cases, and 144 (14%) 3rd round cases by a total of 18 surgeons. Mean operative time was shorter as cases were performed later in the day (213mins vs. 209mins vs. 180mins, p < 0.0001) and similarly estimated blood loss also decreased with surgical order (136mL vs. 134mL vs. 103mL, p=0.01). Transfusion rates, surgical margin rates, and complication rates did not significantly differ between groups. Patients undergoing RARP later in the day were much more likely to have a hospital stay of 2 or more days than earlier cases (10% vs. 11% vs. 32%, p=0.01). CONCLUSIONS Surgical case order influences perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team 'warms up' during the day. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e366 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anil Thomas Los Angeles, CA More articles by this author Armen Derboghossians Los Angeles, CA More articles by this author Allen Chang Los Angeles, CA More articles by this author David Finley Los Angeles, CA More articles by this author Jeff Slezak Los Angeles, CA More articles by this author Brian Kim Los Angeles, CA More articles by this author Steven Jacobsen Los Angeles, CA More articles by this author Gary Chien Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...