Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2016 Oct;196(4):1014-20. doi: 10.1016/j.juro.2016.03.151. Epub 2016 Apr 1.
Previous studies have demonstrated significant variation in recurrence rates after transurethral resection of bladder tumor, likely due to differences in surgical quality. We sought to create a framework to define, measure and improve the quality of transurethral resection of bladder tumor using a surgical checklist.
We formed a multi-institutional group of urologists with expertise with bladder cancer and identified 10 critical items that should be performed during every high quality transurethral bladder tumor resection. We prospectively implemented a 10-item checklist into practice and reviewed the operative reports of such resections performed before and after implementation. Results at all institutions were combined in a meta-analysis to estimate the overall change in the mean number of items documented.
The operative notes for 325 transurethral bladder tumor resections during checklist use were compared to those for 428 performed before checklist implementation. Checklist use increased the mean number of items reported from 4.8 to 8.0 per resection, resulting in a mean increase of 3.3 items (95% CI 1.9-4.7) on meta-analysis. With the checklist the percentage of reports that included all 10 items increased from 0.5% to 27% (p <0.0001). Surgeons who reported more checklist items tended to have a slightly higher proportion of biopsies containing muscle, although not at conventional significance (p = 0.062).
The use of a 10-item checklist during transurethral resection of bladder tumor improved the reporting of critical procedural elements. Although there was no clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement.
先前的研究表明，经尿道膀胱肿瘤切除术的复发率存在显著差异，这可能是由于手术质量的差异所致。我们试图创建一个框架，使用手术清单来定义、衡量和提高经尿道膀胱肿瘤切除术的质量。
我们成立了一个由具有膀胱癌专业知识的泌尿科医生组成的多机构小组，确定了 10 个在高质量经尿道膀胱肿瘤切除术中应进行的关键项目。我们前瞻性地将 10 项检查表纳入实践，并审查了实施前后此类切除术的手术报告。将所有机构的结果合并进行荟萃分析，以估计记录的项目总数的总体变化。
在检查表使用期间，对 325 例经尿道膀胱肿瘤切除术的手术记录与检查表实施前的 428 例进行了比较。检查表的使用使报告的平均项目数从每次切除 4.8 项增加到 8.0 项，平均增加 3.3 项（95%CI 1.9-4.7）。使用检查表，包括所有 10 项的报告比例从 0.5%增加到 27%（p<0.0001）。报告检查表项目较多的外科医生，其活检标本中包含肌肉的比例略高，但没有达到常规意义（p=0.062）。
在经尿道膀胱肿瘤切除术中使用 10 项检查表提高了关键程序要素的报告质量。虽然标本中包含肌肉的情况没有明显改善，但检查表的使用可能会增强外科医生对手术重要方面的关注，并成为提高质量的杠杆。
