The Impact of Implementation of the European Association of Urology Guidelines Panel Recommendations on Reporting and Grading Complications on Perioperative Outcomes after Robot-assisted Radical Prostatectomy

被引:56
作者
Gandaglia, Giorgio [1 ]
Bravi, Carlo Andrea [1 ,2 ]
Dell'Oglio, Paolo [1 ,2 ]
Mazzone, Elio [1 ,2 ]
Fossati, Nicola [1 ]
Scuderi, Simone [1 ,2 ]
Robesti, Daniele [1 ,2 ]
Barletta, Francesco [1 ,2 ]
Grillo, Luca [1 ,2 ]
Maclennan, Steven [3 ]
N'Dow, James [3 ]
Montorsi, Francesco [1 ,2 ]
Briganti, Alberto [1 ,2 ]
机构
[1] IRCCS Osped San Raffaele, URI, Unit Urol, Div Oncogen, Milan, Italy
[2] Univ Vita Salute San Raffaele, Milan, Italy
[3] Univ Aberdeen, Acad Urol Unit, Aberdeen, Scotland
关键词
Complications; EAU guidelines; Perioperative outcomes; Radical prostatectomy; Readmission; CLASSIFICATION; CANCER;
D O I
10.1016/j.eururo.2018.02.025
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
The rate of postoperative complications might vary according to the method used to collect perioperative data. We aimed at assessing the impact of the prospective implementation of the European Association of Urology (EAU) guidelines on reporting and grading of complications in prostate cancer patients undergoing robot-assisted radical prostatectomy (RARP). From September 2016, an integrated method for reporting surgical morbidity based on the EAU guidelines was implemented at a single, tertiary center. Perioperative data were prospectively and systematically collected during a patient interview at 30 d after surgery as recommended by the EAU Guidelines Panel Recommendations on Reporting and Grading Complications. The rate and grading of complications of 167 patients who underwent RARP +/- pelvic lymph node dissection (PLND) after the implementation of the prospective collection system (Group 1) were compared with 316 patients treated between January 2015 and August 2016 (Group 2) when a system based on patient chart review was used. No differences were observed in disease characteristics and PLND between the two groups (all p >= 0.1). Postoperative complications were graded according to the Clavien-Dindo classification system. Overall, the complication rate was higher when the prospective collection system based on the EAU guidelines was used (29%) than when retrospective chart review (10%; p < 0.001) was used. In particular, a substantially higher rate of grade 1 (8.4% vs 4.7%) and 2 (14% vs 2.8%) complications was detected in Group 1 versus Group 2 (p < 0.001). Although the rate of complications occurred during hospitalization did not differ (13% vs 10%; p = 0.3), 31 (19%) complications after discharge were detected in Group 1. This resulted into a readmission rate of 16%. Conversely, no complications after discharge and readmissions were recorded for Group 2. The implementation of the EAU guidelines on reporting perioperative outcomes roughly doubled the complication rate after RARP and allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed, where patients assessed with the EAU implemented protocol had a threefold higher likelihood of reporting complications. Patient summary: The implementation of the European Association of Urology guidelines on reporting and grading of complications after urologic procedures in prostate cancer patients roughly doubled the complication rate after robot-assisted radical prostatectomy compared to retrospective patient chart review. Moreover, it allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:4 / 7
页数:4
相关论文
共 11 条
[1]   Standardized report for early complications of radical prostatectomy [J].
Cheng, Wei-Ming ;
Lin, Tzu-Ping ;
Lin, Chih-Chieh ;
Huang, Eric Yi-Hsiu ;
Chung, Hsiao-Jen ;
Kuo, Junne-Yih ;
Huang, William J. S. ;
Chang, Yen-Hwa ;
Lin, Alex T. L. ;
Chen, Kuang-Kuo .
JOURNAL OF THE CHINESE MEDICAL ASSOCIATION, 2014, 77 (05) :234-241
[2]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[3]   Development and Internal Validation of a Novel Model to Identify the Candidates for Extended Pelvic Lymph Node Dissection in Prostate Cancer [J].
Gandaglia, Giorgio ;
Fossati, Nicola ;
Zaffuto, Emanuele ;
Bandini, Marco ;
Dell'Oglio, Paolo ;
Bravi, Carlo Andrea ;
Fallara, Giuseppe ;
Pellegrino, Francesco ;
Nocera, Luigi ;
Karakiewicz, Pierre I. ;
Tian, Zhe ;
Freschi, Massimo ;
Montironi, Rodolfo ;
Montorsi, Francesco ;
Briganti, Alberto .
EUROPEAN UROLOGY, 2017, 72 (04) :632-640
[4]   Measuring Surgical Quality: Comparison of Postoperative Adverse Events with the American College of Surgeons NSQIP and the Thoracic Morbidity and Mortality Classification System [J].
Ivanovic, Jelena ;
Seely, Andrew J. E. ;
Anstee, Caitlin ;
Villeneuve, Patrick James ;
Gilbert, Sebastien ;
Maziak, Donna E. ;
Shamji, Farid M. ;
Forster, Alan J. ;
Sundaresan, R. Sudhir .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2014, 218 (05) :1024-1031
[5]   Reporting Complications After Open Radical Retropubic Prostatectomy Using the Martin Criteria [J].
Loeppenberg, Bjoern ;
Noldus, Joachim ;
Holz, Alexander ;
Palisaar, Rein Jueri .
JOURNAL OF UROLOGY, 2010, 184 (03) :944-948
[6]   Defining a Standard Set of Patient-centered Outcomes for Men with Localized Prostate Cancer [J].
Martin, Neil E. ;
Massey, Laura ;
Stowell, Caleb ;
Bangma, Chris ;
Briganti, Alberto ;
Bill-Axelson, Anna ;
Blute, Michael ;
Catto, James ;
Chen, Ronald C. ;
D'Amico, Anthony V. ;
Feick, Guenter ;
Fitzpatrick, John M. ;
Frank, Steven J. ;
Froehner, Michael ;
Frydenberg, Mark ;
Glaser, Adam ;
Graefen, Markus ;
Hamstra, Daniel ;
Kibel, Adam ;
Mendenhall, Nancy ;
Moretti, Kim ;
Ramon, Jacob ;
Roos, Ian ;
Sandler, Howard ;
Sullivan, Francis J. ;
Swanson, David ;
Tewari, Ashutosh ;
Vickers, Andrew ;
Wiegel, Thomas ;
Huland, Hartwig .
EUROPEAN UROLOGY, 2015, 67 (03) :460-467
[7]  
Mitropoulos D., 2017, EUR UROL FOCUS
[8]   Reporting and Grading of Complications After Urologic Surgical Procedures: An ad hoc EAU Guidelines Panel Assessment and Recommendations [J].
Mitropoulos, Dionysios ;
Artibani, Walter ;
Graefen, Markus ;
Remzi, Mesut ;
Roupret, Morgan ;
Truss, Michael .
EUROPEAN UROLOGY, 2012, 61 (02) :341-349
[9]   Best Practices in Robot-assisted Radical Prostatectomy: Recommendations of the Pasadena Consensus Panel [J].
Montorsi, Francesco ;
Wilson, Timothy G. ;
Rosen, Raymond C. ;
Ahlering, Thomas E. ;
Artibani, Walter ;
Carroll, Peter R. ;
Costello, Anthony ;
Eastham, James A. ;
Ficarra, Vincenzo ;
Guazzoni, Giorgio ;
Menon, Mani ;
Novara, Giacomo ;
Patel, Vipul R. ;
Stolzenburg, Jens-Uwe ;
Van der Poel, Henk ;
Van Poppel, Hein ;
Mottrie, Alexandre .
EUROPEAN UROLOGY, 2012, 62 (03) :368-381
[10]   Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy [J].
Novara, Giacomo ;
Ficarra, Vincenzo ;
Rosen, Raymond C. ;
Artibani, Walter ;
Costello, Anthony ;
Eastham, James A. ;
Graefen, Markus ;
Guazzoni, Giorgio ;
Shariat, Shahrokh F. ;
Stolzenburg, Jens-Uwe ;
Van Poppel, Hendrik ;
Zattoni, Filiberto ;
Montorsi, Francesco ;
Mottrie, Alexandre ;
Wilson, Timothy G. .
EUROPEAN UROLOGY, 2012, 62 (03) :431-452