Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands; Prostate Cancer Network Netherlands, Amsterdam, The Netherlands.
Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands; Prostate Cancer Network Netherlands, Amsterdam, The Netherlands.
Eur Urol Focus. 2024 Sep;10(5):754-760. doi: 10.1016/j.euf.2024.03.004. Epub 2024 Apr 16.
The implementation of quality assurance programs (QAPs) within urological practice has gained prominence; yet, their impact on outcomes after radical prostatectomy (RP) remains uncertain. This paper aims to systematically review the current literature regarding the implementation of QAPs and their impact on outcomes after robot-assisted RP, laparoscopic RP, and open prostatectomy, collectively referred to as RP.
A systematic Embase, Medline (OvidSP), and Scopus search was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) process, on January 12, 2024. Studies were identified and included if these covered implementation of QAPs and their impact on outcomes after RP. QAPs were defined as any intervention seeking quality improvement through critically reviewing, analyzing, and discussing outcomes. Included studies were assessed critically using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool, with results summarized narratively.
Ten included studies revealed two methodological strategies: periodic performance feedback and surgical video assessments. Despite conceptual variability, QAPs improved outcomes consistently (ie, surgical margins, urine continence, erectile function, and hospital readmissions). Of the two strategies, video assessments better identified suboptimal surgical practice and technical errors. Although the extent of quality improvements did not appear to correlate with the frequency of QAPs, there was an apparent correlation with whether or not outcomes were evaluated collectively.
Current findings suggest that QAPs have a positive impact on outcomes after RP. Caution in interpretation due to limited data is advised. More extensive research is required to explore how conceptual differences impact the extent of quality improvements.
In this paper, we review the available scientific literature regarding the implementation of quality assurance programs and their impact on outcomes after radical prostatectomy. The included studies offered substantial support for the implementation of quality assurance programs as an incentive to improve the quality of care continuously.
在泌尿科实践中实施质量保证计划（QAP）已受到重视；然而，它们对根治性前列腺切除术（RP）后结局的影响仍不确定。本文旨在系统回顾目前关于 QAP 实施及其对机器人辅助 RP、腹腔镜 RP 和开放前列腺切除术（统称为 RP）后结局影响的文献。
根据系统评价和荟萃分析的首选报告项目（PRISMA）流程，于 2024 年 1 月 12 日在 Embase、Medline（OvidSP）和 Scopus 上进行了系统检索。如果研究涵盖了 QAP 的实施及其对 RP 后结局的影响，则将其确定并纳入。QAP 被定义为通过严格审查、分析和讨论结果来寻求质量改进的任何干预措施。使用非随机干预研究的风险偏倚（ROBINS-I）工具对纳入的研究进行严格评估，并以叙述性方式总结结果。
纳入的十项研究揭示了两种方法策略：定期绩效反馈和手术视频评估。尽管概念上存在差异，但 QAP 一致改善了结局（即手术边缘、尿控、勃起功能和住院再入院）。在这两种策略中，视频评估更好地识别了不规范的手术实践和技术错误。虽然质量改进的程度似乎与 QAP 的频率无关，但与是否综合评估结局有关。
目前的研究结果表明，QAP 对 RP 后结局有积极影响。由于数据有限，建议谨慎解释。需要进行更广泛的研究，以探讨概念差异如何影响质量改进的程度。
在本文中，我们回顾了关于实施质量保证计划及其对根治性前列腺切除术后结局影响的现有科学文献。纳入的研究为实施质量保证计划提供了充分的支持，以不断提高护理质量。
