Development and Validation of a Quality Assurance Score for Robot-Assisted Radical Cystectomy

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What are the factors that add up to the best outcomes for patients who have surgery to treat cancer? Looking for a better way to measure quality of care and share best practices in surgical oncology, a team from Roswell Park Cancer Institute developed a quality assessment tool and validated it in a study based on 10 years of prospectively collected data on robot-assisted cystectomies. The researchers, who shared their findings in a paper published by Hussein et al in Urology,1 report that centers that carefully track various aspects of care can better predict patient outcomes and improve patient care. 

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For the study, a team led by Khurshid Guru, MD, Director of Robotic Surgery and Vice Chair of Urology at Roswell Park, set out to identify those elements of care that can be controlled and might therefore represent opportunities for improving care.

“Surgical performance is often evaluated using survival as a measure. However, survival alone may not reliably define surgical performance,” said the study’s first author, Ahmed Aly Hussein, MD, a Clinical Fellow in the Department of Urology at Roswell Park. “It’s important to consider disease severity, comorbidities, and a number of potentially modifiable aspects of care when evaluating surgical performance for a complex disease such as bladder cancer.”

Study Findings

The team developed a measurement tool called the Quality Cystectomy Score (QCS) and tested its ability to predict long-term outcomes. They rated each patient’s clinical outcome on a four-star scale that took into account demographics as well as variables of the clinical care provided before, during, and after surgery, such as the type and technique of urinary diversion, operative time, blood loss, complications, and length of hospital stay.

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Among 425 patients who underwent robot-assisted surgery between 2005 and 2015, most patients (85%) achieved at least three stars, and an even higher number achieved four stars over time. The team’s analysis validated the accuracy and utility of the QCS scoring system, as those patients who were assigned three or four stars had better recurrence-free, cancer-specific, and overall survival.

“These findings show the benefit of applying stringent standards for assessing surgical outcomes and of tracking data continuously and comprehensively,” noted Dr. Guru. “A standardized quality-measurement approach such as the one we created and validated can help provider teams to assess their performance and can also identify areas for improvement, making this tool a valuable resource for patients, their families, and providers as they make important health-care decisions.” ■


1. Hussein AA, Dibaj S, Hinata N, et al: Development and validation of a quality assurance score for robot-assisted radical cystectomy: a 10-year analysis. Urology. August 1, 2016 (early release online).