Surgeon fatigue: impact of case order on perioperative parameters and patient outcomes.
OBJECTIVE
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.


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.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Aditya
A
Bagrodia
Varun
V
Rachakonda
Karen
K
Delafuente
Suzette
S
Toombs
Owen
O
Yeh
Joseph
J
Scales
Claus G
CG
Roehrborn
Yair
Y
Lotan
D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000592:standards* / Q000706:statistics & numerical data*; D011468:Prostatectomy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012371:Robotics / Q000706:statistics & numerical data*; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D014572:Urology