目的:在泌尿外科实践中实施质量保证计划(QAP)已得到重视;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.本文旨在系统地回顾当前有关QAP实施及其对机器人辅助RP后结果的影响的文献,腹腔镜RP,以及开放式前列腺切除术,统称为RP。
方法:系统的Embase,Medline(OvidSP),进行了Scopus搜索,根据系统审查和荟萃分析(PRISMA)过程的首选报告项目,2024年1月12日确定并包括这些研究是否涵盖了QAP的实施及其对RP后结果的影响。QAP被定义为通过批判性审查寻求质量改进的任何干预措施,分析,讨论结果。使用非随机干预研究(ROBINS-I)工具中的偏倚风险对纳入的研究进行了严格评估。对结果进行了叙述性总结。
■10项纳入的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,QAP始终如一地改善了结果(即,手术切缘,尿失禁,勃起功能,和医院再入院)。在这两种策略中,视频评估更好地识别次优手术实践和技术错误。尽管质量改善的程度似乎与QAP的频率无关,与是否对结局进行集体评估有明显的相关性.
结论:目前的研究结果表明,QAP对RP后的结果具有积极影响。由于数据有限,建议谨慎解释。需要更广泛的研究来探索概念差异如何影响质量改进的程度。
结果:在本文中,我们回顾了有关实施质量保证计划及其对根治性前列腺切除术后结局的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实质性支持,以激励不断提高护理质量。
OBJECTIVE: 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.
METHODS: 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.
UNASSIGNED: 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.
CONCLUSIONS: 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.
RESULTS: 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.