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. 2023 Dec 13;9(4):335-344.
doi: 10.3233/BLC-230074. eCollection 2023.

A Procedural Checklist for Transurethral Resection of Bladder Tumors (TURBT) Enhances Operative Dictation and Assesses Surgeon Accuracy of Tumor Characteristic Predictions

Priya Dave  1 , Rutul D Patel  1 , Kush Desai  1 , Jonathan Davila  2 , Alex Sankin  1
Affiliations

A Procedural Checklist for Transurethral Resection of Bladder Tumors (TURBT) Enhances Operative Dictation and Assesses Surgeon Accuracy of Tumor Characteristic Predictions

Priya Dave et al. Bladder Cancer. .

Abstract

Background: A lack of standardization is pervasive in procedural application and reporting templates for TURBT with the use of a surgical checklist proposed as a means for quality improvement.

Objective: To introduce a TURBT checklist to assess surgeon prediction accuracy and the impact of standardized documentation on quality of resection and oncologic outcomes.

Methods: Nine critical elements of a high-quality TURBT identified by literature review were incorporated into a prospectively implemented checklist for operative reports. The checklist included both visualized and predicted tumor characteristics. A retrospective single-institution analysis compared quality of dictation pre- and post-checklist implementation. Surgeon predictions were compared to final pathology reports to determine rates of concordance. Kaplan-Meier curves examined the association of checklist use with recurrence free survival (RFS).

Results: 333 operative reports were included in this analysis, of which 107 (32.1%) were completed pre-checklist implementation. The average number of critical elements reported was 8.69 with checklist use compared to 4.99 without (p < 0.001). There was no significant difference in RFS between the pre- and post-checklist cohorts (log-rank test p = 0.53). Surgeons were least and most accurate in predicting low grade tumor (43.5%) and absence of muscle invasion (96.6%), respectively.

Conclusions: Incorporation of a TURBT surgical checklist improves operative dictation and quality of reporting but did not directly impact RFS. With quality of initial resection a proven correlate to recurrence rates, checklist implementation to improve surgical performance and long-term oncologic outcomes reveals an interesting area of exploration highlighting the need for more standardized methodology when performing these procedures.

Keywords: Transurethral resection of bladder tumor (TURBT); operative checklist; quality improvement; recurrence rates.

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Conflict of interest statement

Priya Dave, MD has no conflicts of interest to report. Rutul D. Patel, DO has no conflicts of interest to report. Kush Desai, BA has no conflicts of interest to report. Jonathan Davila, MD has no conflicts of interest to report. Alex Sankin, MD has no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
a) Overall surgeon checklist accuracy. b) Comparison of surgeon checklist accuracy based on practice volume.
Fig. 2
Fig. 2
Kaplan-Meier curve comparing the effect of checklist use (no vs. yes) at diagnosis on time to tumor recurrence for new patients.
See this image and copyright information in PMC

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