Bibliographic record
Abstract
Introduction and Objectives: Surgical wait times have become a contentious quality indicator in universal health care systems.The potential for cannibalization towards higher priority surgical cases has led to concerns for the inevitable prolonged wait times for non-priority urologic procedures.We describe and evaluate the effect of surgical wait times on the early outcomes and peri-operative complications after transurethral resection of the prostate (TURP).Methods: Patients undergoing TURP for benign disease at a single centre in 2008 were included in this study.Wait times were determined utilizing a prospectively collected administrative database reporting a summary wait time from the time of OR booking to completion of surgery.Clinical data was supplemented by extensive chart review and included patient characteristics such as age, co-morbidity (ASA score) and indication for surgery.Associated outcomes investigated included additional hospitalization or urgent care visits while on the wait list, successful postoperative trial of voiding and complications within three months of surgery.Results: Eighty-four patients with a mean age of 73 were identified having a TURP for benign disease and 46% of patients presented with urinary retention.Mean surgical wait time for the cohort was 59 +/-48 days and there was no significant association with wait times and age or ASA score (Spearman correlation, 0.200, p = 0.07, 0.066, p = 0.547 respectively).There did not appear to be significant triaging of patients based on a presentation of urinary retention.Additional hospital visits for urologic complications was associated with prolonged wait times for TURP (p = 0.03, t-test); however, lower wait times for TURP was significantly associated with early failures of voiding and early postoperative complications (p = 0.02, p = 0.03 respectively; t-test).Dichotomizing wait time data at the median of 48 days confirmed that longer waits for TURP lead decreased postoperative complications (p = 0.033; chi square), including early failures of spontaneous voiding (p = 0.005; chi square) but was led to increased health care visits while waiting for surgery (p = 0.038; chi square).Subset analysis demonstrated that these results appeared to be driven mostly by those with a presentation of urinary retention.Conclusions: Prolonged wait times for urologic surgery are distressing for patients and can be a quality indicator of health care delivery.This retrospective study suggests that modest delays to TURP did not negatively affect early outcomes and, in fact, shorter wait times were associated with higher postoperative complications.However, these findings need to be balanced with higher likelihood of complications and resource utilization during the prolonged waits for surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.596 | 0.240 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".