Association of Crowd-Sourced Assessment of Technical Skills and Outcomes of Robotic-assisted Radical Prostatectomy

Abstract

ObjectiveTo investigate if use of the Crowd-Sourced Assessment of Technical Skills (CSATSTM) platform and video peer review with constructive feedback is associated with improvement in technical skill and patient outcomes for robotic-assisted laparoscopic prostatectomy (RALP). MethodsFive fellowship-trained urologists voluntarily submitted RALP cases for CSATSTM Global Evaluative Assessment of Robotic Skills (GEARS) scoring and expert narrative review between April 15, 2022 - April 30, 2023. Surgeon-selected and randomly-selected cases were reviewed. Surgeons underwent local peer review of videos with constructive feedback. Change in GEARS scores and frequency of post-operative outcomes over the 12-month periods before and during the study were analyzed in logistic regression models. Bias was assessed with sensitivity analysis comparing surgeon-selected to randomly-selected cases. ResultsGEARS scores for randomly-selected versus surgeon-selected cases did not differ significantly. Overall GEARS score correlated positively with annual surgical RALP volume (r=0.39, p=0.003) and negatively with years in practice (r=-0.34, p=0.01). After adjusting for confounders, there was no significant improvement in overall GEARS Score (0.01±0.02/month, p=0.48); but likelihood of sepsis (Odds Ratio 0.07, 95% CI 0.01-1.00, p=0.05) and pelvic fluid collection (Odds Ratio 0.09, 95% CI 0.01-0.99, p=0.049) were significantly decreased during the intervention period (n=165) compared to the prior 12 months (n=144). No outcome increased in likelihood (p>0.05). ConclusionsIntegration of CSATSTM and local video peer review is associated with significant improvement in patient outcomes after RALP, despite no significant change in surgeons’ GEARS scores. This is the first study demonstrating improvement in patient RALP outcomes after implementation of such a paradigm in practicing surgeons.