title: Development and Validation of a Quality Assurance Score for Robot-assisted Radical Cystectomy: A 10-year Analysis.
abstract: To develop quality assessment tool to evaluate surgical performance for robot-assisted radical cystectomy program.
  
  
  
  A prospectively maintained quality assurance database of 425 consecutive robot-assisted radical cystectomies performed by a single surgeon between 2005 and 2015 was retrospectively reviewed. Potentially modifiable factors, related to the management and perioperative care of patients, were used to evaluate patient care. Criteria included the following: preoperative (administration of neoadjuvant chemotherapy); operative (operative time <6.5 hours and estimated blood loss <500 cc); pathologic (negative soft tissue surgical margins and lymph node yield ≥20); and postoperative (no high-grade complications, readmission, or noncancer-related mortality within 30 days).The Quality Cystectomy Score (QCS) was developed (1 star: achieving ≤2 criteria or mortality within 30 days; 2 stars: 3 or 4 criteria met; 3 stars: 5 or 6 criteria met; and 4 stars: 7 or all criteria met). Univariate and multivariate Cox proportional hazard regression models were fitted to test for the association between QCS and survival outcomes.
  
  
  
  Most patients (85%) achieved at least 3 stars, and more patients achieved 4 stars with time. High QCS was associated with better recurrence-free, cancer-specific, and overall survival (P values <.05). None of the patients with 1-star were alive at 1 year. Patients with 4 stars achieved the best survival rates (recurrence-free survival [62%], cancer-specific survival [70%], and overall survival [53%] at 5 years) (log rank P < .0001).
  
  
  
  Continuous assessment for quality improvement facilitated implementation and maintenance of robot-assisted program for bladder cancer.
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, Cairo University, Egypt.
authors: Ahmed A
authors: AA
authors: Hussein
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors: Shiva
authors: S
authors: Dibaj
authors: Department of Urology, Kobe University, Japan.
authors: Nobuyuki
authors: N
authors: Hinata
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors: Erinn
authors: E
authors: Field
authors: Department of Anesthesia, Roswell Park Cancer Institute, Buffalo, NY.
authors: Kathleen
authors: K
authors: O'leary
authors: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY.
authors: Boris
authors: B
authors: Kuvshinoff
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors: James L
authors: JL
authors: Mohler
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors: Gregory
authors: G
authors: Wilding
authors: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: khurshid.guru@roswellpark.org.
authors: Khurshid A
authors: KA
authors: Guru
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*