Are the outcomes, or the patients, different between ureteroscopy procedures performed by consultants compared with those performed by trainees? An analysis of data from the British Association of Urological Surgeons Ureteroscopy database.
BAUS ePoster online library. Conroy S. Jun 24, 2019; 259468; P1-9
Ms. Samantha Conroy
Ms. Samantha Conroy
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Abstract
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INTRODUCTION

The British Association of Urological Surgeons encourages national evaluation of procedural outcomes, aiming to improve surgical standards and transparency for patients. This national audit compares outcomes of ureteroscopic stone surgery between consultants and trainees.

METHODS

4,891 ureteroscopies across 85 sites were evaluated (April 2012-July 2016). 154 were excluded from analysis due to missing/erroneous data. Stone size, number and site were assessed, in addition to stone clearance, length of stay, complications and mortality. Univariate and multivariate analysis were performed using SPSS Version 25 (with correction for co-variables of age, gender, stone size, stone site and number of stones on multivariate analysis).

RESULTS

Analysis of outcomes from 4737 procedures (male-3177, female-1560) was performed. In 74% of ureteroscopies, a consultant was named primary surgeon. There was no significant difference in patient age, but consultants performed more female ureteroscopies (p=0.043), managed larger stones (8mm v 7mm, p<0001), more calyceal stones (p<0.001) and greater number of stones per ureteroscopy (p<0.001).

On univariate analysis, registrars had better surgical and radiological stone clearance (p=0.002 and p<0.001, respectively), and fewer unusual complications (p=0.02); these differences were not significant on multivariate analysis. No significant differences in length of stay, ureteric injuries, post-operative infections or mortality were identified.

Conclusions
The comparable outcomes between consultants and registrars provides confidence in the safety of training in contemporary UK practice. Consultants, however, appear to manage more complex cases (larger, more proximal and multiple stones). This study provides invaluable data on ureteroscopic outcomes to inform pre-operative patient counselling and case selection.
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