title: Impact of hours worked by a urologist prior to performing ureteroscopy on its safety and efficacy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of hours worked by a urologist before performing ureteroscopy on its safety and efficacy.
  
  
  METHODS
  Patients treated at a single institution from January 2010 to December 2013 were analyzed. The study assessed patient, stone and surgical parameters, stone-free rates and intraoperative complications performed in three work duration categories: less than 6 h, 6-12 h and more than 12 h of urologist's work. Statistical analyses included the chi-squared test, Kruskal-Wallis test, and univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  In total, 469 ureteroscopies were analyzed. Intraoperative complications differed non-significantly in the corresponding time categories: ureteral perforations (< 6 h 4.4%, 6-12 h 3.2%, > 12 h 7%, p = 0.46) and avulsions (all 0%). Rates for complete stone removal were 82% within the first 12 h vs 70.2% after 12 h (p = 0.03). Corresponding partial stone-free rates were 4.1% vs 3.5% (p = 0.83) and rates of unsuccessful ureteroscopy were 13.8% vs 26.3% (p = 0.01). In multivariate regression analysis, patients treated after 12 h of urologist's work had a 2.4 times higher risk of an unsuccessful ureteroscopy [odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.2-4.7, p = 0.001] and lower chances of complete stone removal (OR = 0.46, 95% CI 0.24-0.89, p = 0.02). The odds of ureteral perforations were similar (p = 0.28).
  
  
  CONCLUSIONS
  Work duration before ureteroscopy did not affect its safety. Stone-free rates decreased with increasing working time. Working time exceeding 12 h was identified as an independent risk factor for impaired stone-free rates.
authors: a 1 Department of Urology, Landesklinikum Baden-Mödling , Baden, Austria.
authors: Stephan
authors: S
authors: Seklehner
authors: a 1 Department of Urology, Landesklinikum Baden-Mödling , Baden, Austria.
authors: Ortwin
authors: O
authors: Heißler
authors: a 1 Department of Urology, Landesklinikum Baden-Mödling , Baden, Austria.
authors: Paul F
authors: PF
authors: Engelhardt
authors: b 2 Department of Urology, Paracelsus Medical University Salzburg , Salzburg, Austria.
authors: Stephan
authors: S
authors: Hruby
authors: a 1 Department of Urology, Landesklinikum Baden-Mödling , Baden, Austria.
authors: Claus
authors: C
authors: Riedl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries*; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects*; D014572:Urology; D014940:Work Schedule Tolerance; D055815:Young Adult
keywords: Fatigue; minimally invasive; surgical procedures; ureteral calculi; ureteroscopy; work schedule tolerance