Surgeon fatigue

Impact of case order on perioperative parameters and patient outcomes

Aditya Bagrodia, Varun Rachakonda, Karen Delafuente, Suzette Toombs, Owen Yeh, Joseph Scales, Claus G. Roehrborn, Yair Lotan

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: We tested the hypothesis that surgeon fatigue results in worse outcomes for laparoscopic and robot-assisted laparoscopic prostatectomy, and percutaneous nephrolithotomy by comparing outcomes of sequentially scheduled procedures. Materials and Methods: We identified days when 2 procedures of the same type were performed by the same surgeon, including 72 laparoscopic and 340 robot-assisted laparoscopic prostatectomies, and 110 percutaneous nephrolithotomies. Clinical data and outcomes were compared. Results: For percutaneous nephrolithotomy multiple access (16% vs 9%, p = 0.2), transfusion (3.6% vs 5.4%, p = 0.5), complication (20% vs 18%, p = 0.5), residual fragment (53% vs 45%, p = 0.3), second look (38% vs 35% p = 0.4) and stone-free (86% vs 89% p = 0.3) rates did not differ for the first and second procedures. For laparoscopic prostatectomy nerve sparing (100% vs 97.1%, p = 0.5), operative complications (0% vs 0%, p = 0.7), drain requirement (36% vs 42%, p = 0.6) and lymphadenectomy (13.5% vs 25.7%, p = 0.16) rates were comparable. Positive margins (19.4% vs 36.1% p = 0.08), continence (66.7% vs 66.7%, p = 0.9), potency (58.3% vs 52.8%, p = 0.76) and prostate specific antigen recurrence (10.8% vs 20%, p = 0.45) did not significantly differ for the first and second procedures. For robot-assisted laparoscopic prostatectomy operative complications (3% vs 3.5%, p = 0.8), drain requirement (7.7% vs 9.8%, p = 0.5), positive margins (41.7% vs 39.3%, p = 0.37), continence (78.6% vs 84.4%, p = 0.12), potency (51% vs 50%, p = 0.15) and prostate specific antigen recurrence (9.5% vs 11.6%, p = 0.2) did not significantly differ. Nerve sparing was more common in the second case cohort (86.9% vs 75.7%, p = 0.03). Conclusions: Despite concern that surgeon fatigue may impact outcomes, our data suggests that performing several complex urological procedures consecutively is not associated with worse outcomes.

Original languageEnglish (US)
Pages (from-to)1291-1296
Number of pages6
JournalJournal of Urology
Volume188
Issue number4
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

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Fatigue
Prostatectomy
Percutaneous Nephrostomy
Prostate-Specific Antigen
Recurrence
Lymph Node Excision
Surgeons

Keywords

  • fatigue
  • kidney
  • prostate
  • surgery
  • task performance and analysis

ASJC Scopus subject areas

  • Urology

Cite this

Bagrodia, A., Rachakonda, V., Delafuente, K., Toombs, S., Yeh, O., Scales, J., ... Lotan, Y. (2012). Surgeon fatigue: Impact of case order on perioperative parameters and patient outcomes. Journal of Urology, 188(4), 1291-1296. https://doi.org/10.1016/j.juro.2012.06.021

Surgeon fatigue : Impact of case order on perioperative parameters and patient outcomes. / Bagrodia, Aditya; Rachakonda, Varun; Delafuente, Karen; Toombs, Suzette; Yeh, Owen; Scales, Joseph; Roehrborn, Claus G.; Lotan, Yair.

In: Journal of Urology, Vol. 188, No. 4, 01.10.2012, p. 1291-1296.

Research output: Contribution to journalArticle

Bagrodia, A, Rachakonda, V, Delafuente, K, Toombs, S, Yeh, O, Scales, J, Roehrborn, CG & Lotan, Y 2012, 'Surgeon fatigue: Impact of case order on perioperative parameters and patient outcomes', Journal of Urology, vol. 188, no. 4, pp. 1291-1296. https://doi.org/10.1016/j.juro.2012.06.021
Bagrodia, Aditya ; Rachakonda, Varun ; Delafuente, Karen ; Toombs, Suzette ; Yeh, Owen ; Scales, Joseph ; Roehrborn, Claus G. ; Lotan, Yair. / Surgeon fatigue : Impact of case order on perioperative parameters and patient outcomes. In: Journal of Urology. 2012 ; Vol. 188, No. 4. pp. 1291-1296.
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N2 - Purpose: We tested the hypothesis that surgeon fatigue results in worse outcomes for laparoscopic and robot-assisted laparoscopic prostatectomy, and percutaneous nephrolithotomy by comparing outcomes of sequentially scheduled procedures. Materials and Methods: We identified days when 2 procedures of the same type were performed by the same surgeon, including 72 laparoscopic and 340 robot-assisted laparoscopic prostatectomies, and 110 percutaneous nephrolithotomies. Clinical data and outcomes were compared. Results: For percutaneous nephrolithotomy multiple access (16% vs 9%, p = 0.2), transfusion (3.6% vs 5.4%, p = 0.5), complication (20% vs 18%, p = 0.5), residual fragment (53% vs 45%, p = 0.3), second look (38% vs 35% p = 0.4) and stone-free (86% vs 89% p = 0.3) rates did not differ for the first and second procedures. For laparoscopic prostatectomy nerve sparing (100% vs 97.1%, p = 0.5), operative complications (0% vs 0%, p = 0.7), drain requirement (36% vs 42%, p = 0.6) and lymphadenectomy (13.5% vs 25.7%, p = 0.16) rates were comparable. Positive margins (19.4% vs 36.1% p = 0.08), continence (66.7% vs 66.7%, p = 0.9), potency (58.3% vs 52.8%, p = 0.76) and prostate specific antigen recurrence (10.8% vs 20%, p = 0.45) did not significantly differ for the first and second procedures. For robot-assisted laparoscopic prostatectomy operative complications (3% vs 3.5%, p = 0.8), drain requirement (7.7% vs 9.8%, p = 0.5), positive margins (41.7% vs 39.3%, p = 0.37), continence (78.6% vs 84.4%, p = 0.12), potency (51% vs 50%, p = 0.15) and prostate specific antigen recurrence (9.5% vs 11.6%, p = 0.2) did not significantly differ. Nerve sparing was more common in the second case cohort (86.9% vs 75.7%, p = 0.03). Conclusions: Despite concern that surgeon fatigue may impact outcomes, our data suggests that performing several complex urological procedures consecutively is not associated with worse outcomes.

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