Evaluating open radical prostatectomy in the era of centralisation and the robot - analysis of the British Association of Urological Surgeons complex operations database
BAUS ePoster online library. John J. 11/10/20; 304154; P10-6 Disclosure(s): None
Mr. Joseph John
Mr. Joseph John
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Evaluating open radical prostatectomy in the era of centralisation and the robot - analysis of the British Association of Urological Surgeons complex operations database

John J1, Pascoe J1, Fowler S2, Walton T3, Johnson M4, Aning J5, Challacombe B2,6, Dickinson A2,7, McGrath J1,2
1Royal Devon and Exeter NHS Foundation Trust, United Kingdom, 2British Association of Urological Surgeons, London, United Kingdom, 3Nottingham University Hospitals NHS Trust, United Kingdom, 4Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom, 5North Bristol NHS Trust, United Kingdom, 6Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 7Plymouth University Hospitals, United Kingdom

Introduction:
Radical prostatectomy (RP) in the UK is now typically performed in high-volume centres by high-volume surgeons, in accordance with national guidance. Robot-assisted RP (RARP) is now more frequently utilised than open RP (ORP).

Objective:
To understand modern ORP practices in England.
Materials and Methods: BAUS manage the complex operations database for RP. Surgical departments upload data describing patient, disease, surgical, pathological and outcome factors. Surgeons can review and amend their data before lockdown and data cleansing. All 1,692 ORPs from a total 21,973 RPs recorded in England (2016-18) were analysed.

Results:
Median age was 66 and 73% were ASA 1-2. Median PSA was 8 (IQR 6-12). Patients had pre-operative Gleason score ≥7 in 82% of cases. Pre-operative T-stages 1, 2, 3 and 4 were recorded in 19%, 53%, 16% and 0.2% of cases respectively. From a total 69 ORP surgeons, 13 (19%) high-volume ORP surgeons (≥15 annual cases) performed 82% of ORPs. The remaining 18% were performed by 56 surgeons (81%) who performed <15 annual cases (Figure 1). High-volume surgeons' operative and outcome descriptors are shown in table 1.

Conclusions:
The majority of contemporary ORPs are performed by a low number of high-volume surgeons. Disease characteristics of ORP patients reflect the wider RP cohort. Specific ORP indications include prior abdominopelvic surgery, contraindications to Trendelenburg positioning, and unforeseen robotic equipment failure. Low rates of transfusion/Clavien-Dindo complications ≥3 indicate ORP performed by high-volume surgeons to be safe in this current series. A requirement for ORP expertise is likely to remain.
Evaluating open radical prostatectomy in the era of centralisation and the robot - analysis of the British Association of Urological Surgeons complex operations database

John J1, Pascoe J1, Fowler S2, Walton T3, Johnson M4, Aning J5, Challacombe B2,6, Dickinson A2,7, McGrath J1,2
1Royal Devon and Exeter NHS Foundation Trust, United Kingdom, 2British Association of Urological Surgeons, London, United Kingdom, 3Nottingham University Hospitals NHS Trust, United Kingdom, 4Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom, 5North Bristol NHS Trust, United Kingdom, 6Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 7Plymouth University Hospitals, United Kingdom

Introduction:
Radical prostatectomy (RP) in the UK is now typically performed in high-volume centres by high-volume surgeons, in accordance with national guidance. Robot-assisted RP (RARP) is now more frequently utilised than open RP (ORP).

Objective:
To understand modern ORP practices in England.
Materials and Methods: BAUS manage the complex operations database for RP. Surgical departments upload data describing patient, disease, surgical, pathological and outcome factors. Surgeons can review and amend their data before lockdown and data cleansing. All 1,692 ORPs from a total 21,973 RPs recorded in England (2016-18) were analysed.

Results:
Median age was 66 and 73% were ASA 1-2. Median PSA was 8 (IQR 6-12). Patients had pre-operative Gleason score ≥7 in 82% of cases. Pre-operative T-stages 1, 2, 3 and 4 were recorded in 19%, 53%, 16% and 0.2% of cases respectively. From a total 69 ORP surgeons, 13 (19%) high-volume ORP surgeons (≥15 annual cases) performed 82% of ORPs. The remaining 18% were performed by 56 surgeons (81%) who performed <15 annual cases (Figure 1). High-volume surgeons' operative and outcome descriptors are shown in table 1.

Conclusions:
The majority of contemporary ORPs are performed by a low number of high-volume surgeons. Disease characteristics of ORP patients reflect the wider RP cohort. Specific ORP indications include prior abdominopelvic surgery, contraindications to Trendelenburg positioning, and unforeseen robotic equipment failure. Low rates of transfusion/Clavien-Dindo complications ≥3 indicate ORP performed by high-volume surgeons to be safe in this current series. A requirement for ORP expertise is likely to remain.
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