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 Scopus citations

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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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., Roehrborn, C. G., & 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