Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts RPE-05 The Impact of Covid-19 on Urologic Surgery Residency and Wellbeing in the US and EU C. Goldman 1 , B. Pradere 2 , M. Mete 3 , M. Talso 4 , R. Bernardino 5 , R. Campi 6 , D. Marchalik 3 1 MedStar Georgetown University Hospital, Washington, DC, USA; 2 Comprehensive Cancer Center Medical University of Vienna, Vienna, Austria; 3 MedStar Health Office of Physician Wellbeing, Columbia, MD, USA; 4 ASST Fatebenefratelli Sacco Luigi Sacco University Hospital, Milan, Italy; 5 Central lisbon University Hospital Center, Lisbon, Portugal; 6 University of Florence, Florence, Italy Introduction and Objective: To assess changes to the experiences and wellbeing of urology trainees in the United States (US) and European Union (EU) during the COVID-19 pandemic. Methods: A 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the United States. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety using validated questionnaires, as well as 38 COVID-19 specific questions and demographics. Two sample t-tests, chi-square tests, and paired t-tests were used to compare results. Results: Two hundred twenty-three urology residents responded to the survey with an overall response rate of 16.5%. Surgical exposure was the largest educational concern for 81% of US and 48% of EU residents. E-learning was utilizedby 100%ofUS and57%of EUresidentswith two-thirds finding it equally or more useful than traditional didactics. With regards towell-being: 73%of US and 71% of EU residents reported good to excellent quality of life during the pandemic. No significant differenceswere seen comparingburnout, professional fulfillment, depression, anxiety, or loneliness amongUS or EUresidents. Burnout was endorsed in 53% of residents. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (p < 0.001) and residents spent more time using telehealth and working from home during the pandemic. Residents spent more time on research projects, didactic lectures, non-medical hobbies, and non-medical reading during the pandemic. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research. Conclusions: TheCOVID-19 pandemic has resulted in significant restructuring of residents’ educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it. Don’t Skirt the Question: Lead Bed Skirts in the OR, an Intervention T. Mueller, K. Klimowich, J. Thatcher Rowan University School of Osteopathic Medicine, Stratford, NJ, USA Introduction andObjective: Fluoroscopy is an important tool in endourology and is often used throughout urologic training. Extrapolated data collected from our OR using real time dosimeters showed that despite using low dose technology, leaded aprons, and thyroid shields, the standard dose a resident receives over one year is 11% over the annual radiation dose limit to the eyes and near the annual dose limit for the entire body. The aim of our study is to reduce radiation exposure to the primary surgeon and anesthesia by installing a lead skirt around the operating table. Methods: We placed a lead skirt around the operating table and used Radex One Quarta Geiger dosimeters at the level of the eyes, buttocks, anesthesia outer chest pocket, and adjacent to the x-ray tube to collect radiation exposure levels during procedures. We compared these data with data collected using the same configuration without a lead operating table skirt. Results: Radiation exposure to various body parts during eighty-one endourologic procedures over a six-month periodwas tabulated. The highest amount of radiation receivedwas to the eyes and buttocks. Installing a leaded skirt around the table attenuated the radiation scatter to all areas. Most notably, radiation to the eyes and buttocks was reduced by nearly 500% and 200%, respectively. This reflects a potential intervention that is simple and revolutionary in fluoroscopy. Conclusions: Residents and anesthesia personnel are exposed to high amounts of radiation during fluoroscopic procedures. Alead skirt around the operating table significantly reduces radiation scatter in the operating room. This represents an inexpensive and innovative improvement to operating room safety and can be used across multiple specialties. RPE-03 Resident Prize Essay Podium Session 3 Harnessing Choice Architecture in Urologic Practice: Implementation of an Opioid-Sparing Protocol Grounded in Cognitive Behavioral Theory A. Bernstein 1 , A. Nourian 1,2 , M. Strother 1 , R. Viterbo 1,2 , R. Greenberg 1,2 , M. Smaldone 1,2 , A. Correa 1,2 , R. Uzzo 1,2 , A. Kutikov 1,2 1 Fox Chase Cancer Center, Philadelphia, PA, USA; 2 Einstein Healthcare Network, Philadelphia, PA, USA Introduction and Objective: As many urologic procedures are performed minimally invasively, an opportunity exists to push forward initiatives to minimize postoperative opioid use. Here we report an effort to change entrenched clinical practice based onmodern behavioral economics principles. Methods: A quality improvement initiative to reduce inpatient opioid prescribing was launched at a tertiary cancer referral center. In phase I (December 2019-July 2020), providers were instructed to start patients on standing acetaminophen. In Phase II (beginning August 2020), education was provided to the entire care team and order sets were modified to reflect an opioid sparing protocol (OSP). We analyzed the proportion of minimally invasive surgery (MIS) prostatectomy and nephrectomy patients that adhered to an OSP during each phase and compared them to controls from the preceding 2 years. RPE-04 Results: 303, 153, and 839 patients underwent MIS during the phase I, phase II, and control periods respectively. The proportion of patients adhering to an OSP increased from 16% at the beginning of phase I to 76% at the end of phase II (p-trend<0.001). The median total oral morphine equivalents (OME) for oral opioids declined from 20 mg and 40 mg during the control period for prostatectomy and nephrectomy patients respectively to 0 mg for both groups (p-trends<0.001). Multivariable logistic regression adjusting for history of anxiety or depression, surgery type, age and gender, found that patients received 22% and 81% less OME during phase I and II respectively (p<0.001; p<0.001). Conclusions: Adherence to an OSP is most effective when initiatives incorporate the entire care team and are supported by nudge therapy-based structural changes. Using these strategies, most patients following urologic MIS can dramatically reduce or eliminate opioid use postoperatively.