Development of a new radical cystectomy surveillance protocol and nurse-led cystectomy follow-up clinic in Australia.

IF 1.5 4区医学 Q3 SURGERY ANZ Journal of Surgery Pub Date : 2024-10-16 DOI:10.1111/ans.19272

Ashley Lee, Katherine Ong, Mohammed Al-Zubaidi, Tracey Goodall, Cynthia Hawks, Steve P McCombie, Dickon Hayne

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Abstract

Background: This study determined, implemented, and assessed a nurse-led radical cystectomy follow-up protocol.

Methods: In 2021, an evidence-based risk-stratified protocol (non-urological cancers and benign [N-UC&B], low, or high risk) was developed from current guidelines, local and national expert opinion, and after formal discussion with the Urological Society of Australia and New Zealand (USANZ) Western Australia (WA) and Australia and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group. Retrospective and prospective assessment of cystectomy follow-up occurred between 2015 and 2023. Patients received 'surgeon-led' follow-up March 2015 to August 2021, and 'nurse-led' follow-up August 2021 to April 2023. Adherence to follow-up, cost-analysis, and healthcare efficiency calculations were performed.

Results: Of 176 cystectomy patients, 159 (90.3%) were eligible for inclusion. Overall adherence to nurse-led follow-up was 78.6% compared to 43.4% in surgeon-led (P < 0.001). Adherence to nurse-led follow-up was higher in all risk categories (high-risk 79.1% vs. 43%, P < 0.001; low risk 75% vs. 52.3%, P = 0.110; N-UC&B 71% vs. 30%, P = 0.153). Nurse-led consultation saved $59.50 per consultation with overall cost savings of $179.50, $416.50, and $595 for the entire follow-up period for N-UC&B, low, and high-risk groups based on consultation alone. A total of 1072 appointments (536 h, $62 390.40) would have been saved if the surgeon-led cohort of patients were seen in nurse-led clinics.

Conclusion: Protocol driven nurse-led cystectomy follow-up demonstrates excellent adherence and may be more cost-effective than surgeon-led follow-up.

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在澳大利亚制定新的根治性膀胱切除术监控方案和护士主导的膀胱切除术随访诊所。

背景：本研究确定、实施并评估了护士主导的根治性膀胱切除术随访方案：本研究确定、实施并评估了由护士主导的根治性膀胱切除术随访方案：2021年，在与澳大利亚和新西兰泌尿外科学会（USANZ）西澳大利亚（WA）以及澳大利亚和新西兰泌尿生殖系统和前列腺（ANZUP）癌症试验小组正式讨论后，根据现行指南、当地和全国专家意见制定了循证风险分级方案（非泌尿系统癌症和良性[N-UC&B]、低风险或高风险）。膀胱切除术随访的回顾性和前瞻性评估发生在2015年至2023年之间。患者在2015年3月至2021年8月期间接受 "外科医生主导 "的随访，在2021年8月至2023年4月期间接受 "护士主导 "的随访。对随访的依从性、成本分析和医疗效率进行了计算：在176例膀胱切除术患者中，159例（90.3%）符合纳入条件。护士主导随访的总体坚持率为 78.6%，而外科医生主导随访的坚持率为 43.4%（P 结论：护士主导随访的总体坚持率为 78.6%，而外科医生主导随访的坚持率为 43.4%）：与外科医生主导的随访相比，护士主导的膀胱切除术随访具有极高的依从性和成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.

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