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Re: Morbidity of Urologic Surgical Procedures: An Analysis of Rates, Risk Factors, and Outcomes
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
1071
music and overhead pages. In this study 90 general surgery cases were assessed by a surgeon and a behavioral scientist using 4 validated tools. Distractions included those initiated by external staff, case irrelevant conversations, equipment related distractions and acoustic distractions. Across all levels distractions were associated with decreased teamwork scores, greater surgeon stress and increased workload. Thus, while distractions are often unavoidable in the OR, such distractions can have a negative impact on the surgeon, the anesthesiologist and the OR team. Whether this finding translates to poorer patient outcomes is unclear. Urologists should try to be proactive in minimizing distractions in the OR rather than being forced to “filter them out.” David S. Wang, MD
Re: Morbidity of Urologic Surgical Procedures: An Analysis of Rates, Risk Factors, and Outcomes H. D. Patel, M. W. Ball, J. E. Cohen, M. Kates, P. M. Pierorazio and M. E. Allaf James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland Urology 2015; 85: 552e559.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.062 available at http://jurology.com/ Editorial Comment: The authors examined 30-day complications in patients undergoing urological surgery from the National Surgical Quality Improvement ProgramÒ. Nearly 40,000 procedures were included in the analysis. Major surgical cases that had the greatest complication rates (in order) were cystectomy (56%), nephrectomy (21%), retroperitoneal lymph node dissection (20%) and radical retropubic prostatectomy (19%). Consistent with many other series of radical cystectomy, average length of stay was 10.8 days, and 56% of patients experienced at least 1 postoperative complication. Endoscopic cases that had the highest complications were transurethral resection of bladder tumor (11%) and transurethral prostatectomy (10%). It is likely that in the future hospitals and insurance companies will use large studies such as this to benchmark expected complication rates following specific surgical procedures to determine if there are deficiencies in patient care and/or opportunities for improvement. David S. Wang, MD
Re: The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis S. Deng, Q. Dong, J. Wang and P. Zhang Department of Urology, West China Hospital, Sichuan University, Chengdu, China Urol Int 2014; 92: 339e348.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.063 available at http://jurology.com/ Editorial Comment: An increasing number of trials are showing that routine bowel preparation before ileal loop urinary diversion is unnecessary. At our institution our colleagues in general surgery do not routinely administer mechanical bowel preparation before bowel surgery. This meta-analysis included 2 randomized trials and 5 cohort studies. There was no difference in any outcome measured, including return of bowel function, other morbidity, mortality and rehospitalization rates, when comparing patients who did and did not receive mechanical bowel preparation. This study suggests that mechanical bowel preparation is unnecessary in patients undergoing routine ileal loop urinary diversion. David S. Wang, MD
1071
music and overhead pages. In this study 90 general surgery cases were assessed by a surgeon and a behavioral scientist using 4 validated tools. Distractions included those initiated by external staff, case irrelevant conversations, equipment related distractions and acoustic distractions. Across all levels distractions were associated with decreased teamwork scores, greater surgeon stress and increased workload. Thus, while distractions are often unavoidable in the OR, such distractions can have a negative impact on the surgeon, the anesthesiologist and the OR team. Whether this finding translates to poorer patient outcomes is unclear. Urologists should try to be proactive in minimizing distractions in the OR rather than being forced to “filter them out.” David S. Wang, MD
Re: Morbidity of Urologic Surgical Procedures: An Analysis of Rates, Risk Factors, and Outcomes H. D. Patel, M. W. Ball, J. E. Cohen, M. Kates, P. M. Pierorazio and M. E. Allaf James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland Urology 2015; 85: 552e559.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.062 available at http://jurology.com/ Editorial Comment: The authors examined 30-day complications in patients undergoing urological surgery from the National Surgical Quality Improvement ProgramÒ. Nearly 40,000 procedures were included in the analysis. Major surgical cases that had the greatest complication rates (in order) were cystectomy (56%), nephrectomy (21%), retroperitoneal lymph node dissection (20%) and radical retropubic prostatectomy (19%). Consistent with many other series of radical cystectomy, average length of stay was 10.8 days, and 56% of patients experienced at least 1 postoperative complication. Endoscopic cases that had the highest complications were transurethral resection of bladder tumor (11%) and transurethral prostatectomy (10%). It is likely that in the future hospitals and insurance companies will use large studies such as this to benchmark expected complication rates following specific surgical procedures to determine if there are deficiencies in patient care and/or opportunities for improvement. David S. Wang, MD
Re: The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis S. Deng, Q. Dong, J. Wang and P. Zhang Department of Urology, West China Hospital, Sichuan University, Chengdu, China Urol Int 2014; 92: 339e348.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.063 available at http://jurology.com/ Editorial Comment: An increasing number of trials are showing that routine bowel preparation before ileal loop urinary diversion is unnecessary. At our institution our colleagues in general surgery do not routinely administer mechanical bowel preparation before bowel surgery. This meta-analysis included 2 randomized trials and 5 cohort studies. There was no difference in any outcome measured, including return of bowel function, other morbidity, mortality and rehospitalization rates, when comparing patients who did and did not receive mechanical bowel preparation. This study suggests that mechanical bowel preparation is unnecessary in patients undergoing routine ileal loop urinary diversion. David S. Wang, MD