Exploring the relationship between online service failure, recovery strategies and customer satisfaction

This paper aims to analyse perceptions of online service failure-recovery and customer retention in relation to the creation of satisfactory experiences for both customer and providers in the banking sector. In specific, the negative impacts of service failures and the positive effect of recovery strategies are assessed. Online service failures can have adverse impacts on profitability, and on- and offline service failures are inevitable in the service industry. A number of observations are made with implications for customer and provider experience in the banking sector. The purpose of this paper is to divulge predominant academic insight into a consistent provider-customer interaction and unlocks new perceptions for future academic study by examining the phenomenon from the perspectives of both providers and customers

Exploring the relationship between online service failure, recovery strategies and customer satisfaction

This paper aims to analyse perceptions of online service failure-recovery and customer retention in relation to the creation of satisfactory experiences for both customer and providers in the banking sector. In specific, the negative impacts of service failures and the positive effect of recovery strategies are assessed. Online service failures can have adverse impacts on profitability, and on-and offline service failures are inevitable in the service industry. A number of observations are made with implications for customer and provider experience in the banking sector. The purpose of this paper is to divulge predominant academic insight into a consistent provider-customer interaction and unlocks new perceptions for future academic study by examining the phenomenon from the perspectives of both providers and customers

Comparison of survival outcomes for African American and Caucasian men with advanced penile cancer in Florida

490 Background: Studies suggest that there may be disparity in clinical outcomes for African−American men (AAM) compared to Caucasian men (CM) with penile squamous cell carcinoma (SCC). We sought to determine whether there was a survival difference for African American versus Caucasian men, particularly in locally advanced and metastatic cases of penile SCC where disease mortality is highest. Methods: Using the Florida Cancer Data System, we identified men diagnosed with penile SCC, from 2004 to 2014. We excluded men who were diagnosed on autopsy or at the time of death and with < 6 months of follow up. Demographic variables including: age, follow−up, stage, race and treatment type were compared between AAM and CM. Treatment type was categorized as surgery alone or surgery plus additional therapy (chemotherapy and/or radiation). For locally advanced and metastatic disease, we compared treatment type and overall survival (OS) between AAM and CM. A multivariable model was developed to determine significant predictors of OS. Results: Of the 653 men with penile SCC, 198 [38 (19%) AAM and 160 (81%) CM] had locally advanced and/or metastatic disease. Median follow up for the entire cohort was 12.5 mos. For all stages, AAM demonstrated a significantly decreased median OS compared to CM (26 vs. 37 mos, p=0.03). For locally advanced and metastatic disease, there was a persistent, but non−significant, trend toward disparity in median OS between AAM and CM (17 vs. 23 mos, p=0.06). Fewer AAM compared to CM received surgery plus additional therapy for locally advanced and/or metastatic disease [8 (21%) vs. 42 (26%)], but this difference was not statistically significant. After adjusting for age, stage, and treatment type, AAM had increased likelihood of death from penile SCC (HR 1.63, p=0.015). Conclusions: Mortality rates from penile SCC remain high in contemporary series. For AAM in Florida, advanced stage at presentation, along with treatment disparity, may partially explain decreased survival rates. Further studies are needed to determine the additional socioeconomic, as well as potential biologic, factors that may predict the relatively poor outcome observed in AA men with penile SCC

Defining the optimal PSA range for the maximal predictive efficacy of PSA density to detect prostate cancer on biopsy: Results from a multi-institutional and prospective contemporary cohort

70 Background: PSA density (PSAD) is an important predictor of prostate cancer (PCa). We assessed whether the predictive accuracy of PSAD varied based on the range of PSA or whether the patient had a previous negative prostate biopsy (PB). Methods: We assessed a prospective cohort of men who were referred for a PB due to suspicion of PCa at 26 different sites across USA. The area under the receiver operating characteristic curve (AUC) was used to assess the added predictive accuracy of PSAD versus PSA across 3 different PSA ranges ( 10 ng/mL) and in men with or without a prior negative PB for the detection of any and significant (Gleason ≥ 7) PCa. Results: Of the 1,290 men, 585 (45%) and 284 (22%) had any and significant PCa, respectively. PSAD was significantly more predictive than PSA for detecting any PCa in the PSA ranges of 4 – 10 (AUC 0.70 vs 0.53, P 10 (AUC 0.84 vs 0.65, P 10 (AUC 0.82 vs 0.68, P = 0.0001) ng/mL. Furthermore, PSAD was significantly more predictive than PSA in detecting PCa in men that had a prior negative PB (AUC 0.69 vs 0.56, P = 0.0001 for any PCa and AUC 0.81 vs 0.70, P = 0.0042 for significant PCa), and those that didn’t (AUC 0.72 vs 0.67, P = 0.0001 for any PCa and AUC 0.77 vs 0.73, P = 0.0026 for significant PCa). However the difference between the AUC of PSAD and PSA (ΔAUC) was a lot more pronounced in men that had a prior negative PB (ΔAUC = 0.13 for any PCa and ΔAUC = 0.11 for significant PCa) as opposed to those that didn’t (ΔAUC = 0.05 for any PCa and ΔAUC = 0.04 for significant PCa), suggesting that PSAD is a much better predictor than PSA alone in men who have undergone a previous PB. Conclusions: As PSA increases, the predictive accuracy of PSAD over PSA appears to improve for the detection of any PCa and significant PCa. Additionally, PSAD has a more pronounced predictive value over PSA in detecting any and significant PCa in men who have undergone a prior negativePB. We support the use of PSAD testing to avoid unnecessary biopsies in men who have elevated PSA secondary to an enlarged prostate

Can PSA density and free-to-total PSA ratio improve our ability to predict prostate cancer on biopsy? Results from a prospective, multi-institutional, and contemporary cohort

57 Background: Several studies have reported an increased value of PSA density (PSAD) and free−to−total PSA ratio (f/t PSA) over PSA alone in predicting prostate cancer (PCa). Despite this, they remain underutilized. This study analyzed a cohort of men referred for prostate biopsy (PB) to determine if PSAD and f/t PSA enhanced the prediction of any PCa and/or significant PCa (Gleason score ≥ 7) compared to PSA. Methods: 1,370 prospectively enrolled patients were referred for a PB across 26 urological centers. A phlebotomy was performed immediately prior to PB for PSA and f/t PSA measurement. PSAD was calculated using prostate volume obtained during the trans−rectal ultrasound (TRUS) guided PB. The area under the receiver operating characteristic curve (AUC) was used to assess the added discriminative value of PSAD and f/t PSA when added to a base model consisting of PSA, age, prior biopsy status, and DRE for the prediction of any and significant PCa. Results: Of the 1,290 men in the final cohort, 301 (23%) and 284 (22%) men were diagnosed with low−grade (Gleason score = 6) and significant PCa respectively. The median PSAD values in men with no PCa, low−grade PCa, and significant PCa were 0.09, 0.11, and 0.17 ng/mL/cc, respectively (P < 0.0001). The median f/t PSA in men with no PCa, low−grade PCa, and significant PCa was 0.21, 0.17, and 0.12 respectively (P < 0.0001). The AUC for a model incorporating PSAD showed superior predictive value compared to the base model for diagnosing any PCa (AUC 0.76 versus 0.70, P < 0.0001) and significant PCa (AUC 0.82 versus 0.77, P < 0.0001). Similarly, a model with f/t PSA showed superior predictive value compared to the base model for diagnosing any PCa (AUC 0.73 vs 0.70, P < 0.0001) and significant PCa (AUC 0.82 versus 0.77, P < 0.0001). While PSAD showed superior predictive value over f/t PSA for predicting any PCa (AUC 0.76 versus 0.73, P = 0.0062), there was no difference in their discrimination of significant PCa. Conclusions: PSAD and f/t PSA add substantial predictive power to the diagnostic armamentarium for any and significant PCa. Their calculation may reduce the number of unnecessary biopsies being performed for PCa detection

Does variation in prostate volume calculated with MRI versus TRUS lead to reclassification of men based on current PSA density threshold for active surveillance criteria? Result from a prospective cohort

138 Background: PSA density (PSAD) is a strong predictor of aggressive prostate cancer (PCa) and is often used as a selection criterion for active surveillance. However, measurement of PSAD can vary depending on the modality used to estimate prostate volume (PV). We analyzed a prospective cohort of men undergoing MRI−US fusion biopsy to assess the variation in PV obtained with both imaging modalities, and investigate the impact of this variation on PSAD measurement in order to determine if it led to re-classification of patients above or below the current threshold of PSAD used in clinical practice (0.15 ng/mL/cc). Methods: All men were consecutively enrolled in this prospective study and had their PV measured on MRI prior to prostate biopsy (PB), and on Trans-Rectal Ultrasound (TRUS) at the time of PB. PSAD was calculated by dividing the last PSA prior to biopsy by the PV ascertained with each imaging modality. We used paired t-tests and Wilcoxon signed−rank tests to compare the difference in PV and PSAD obtained with TRUS and MRI. We also categorized PSAD measurements on each imaging modality above and below a cut-off of 0.15 ng/mL/cc. We used the McNemar’s test for paired proportions to estimate the significance of discordance in PSAD categorization based on each imaging modality. Results: Of the 124 men, the mean PV assessed with MRI (70 cc) was 7 cc more on average (SD: 11, median = 4 cc) than that obtained with TRUS (63 cc) (P < 0.0001). Furthermore, the mean PSAD obtained with MRI (0.17 ng/mL/cc), was 0.01 ng/mL/cc lower (SD: 0.07, median = 0.01) than that obtained with TRUS (0.18 ng/mL/cc) (P < 0.0001). 118 (95%) men had concordant PSAD values assessed with either imaging modality using the cut-off of 0.15 ng/mL/cc. All 6 (5%) men with discordant PSAD values who were above the cut-off with PV obtained via TRUS were reclassified as being below the cut-off with PV assessed via MRI (P < 0.01). Conclusions: MRI can overestimate PV compared to TRUS. This may translate to reclassification of men around the currently used PSAD threshold and have implications for treatment decision making and selection of patients for active surveillance

MP69-07 IMPACT OF PELVIC LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY ON 30-DAY POST OPERATIVE COMPLICATIONS: RESULTS FROM A LARGE NATIONAL DATABASE

238 Background: Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most effective method for detecting lymph node metastases in patients with prostate cancer. The association between PLND during RP and morbidity, especially thromboembolic adverse events (AEs), remains unclear. We assessed the effect of PLND on 30−day postoperative AEs in patients undergoing RP using the American College of Surgeons’ National Surgical Quality Improvement Program database (NSQIP). Methods: A total of 21,895 men undergoing RP between 2006 and 2013 were classified into two groups according to surgical approach (MIS−RP vs. ORP) and whether PLND was performed. Multivariate logistic regression adjusting for approach and demographic features was performed to assess the impact of PLND for predicting two primary endpoints (overall complications and major complications defined as Clavien−Dindo ≥ 3) and for 17 types of complications. P−values were adjusted to maintain an experiment−wise p &lt; 0.05. Results: MIS−RP and ORP was performed in 17,354 (79.3%) and 4,541 (20.7%) patients, respectively. PLND was performed in 7,579 (43.7%) and 3,597 (79.2%) patients in the MIS−RP and ORP groups, respectively. The overall postoperative complication rate was 8.7% (5.5% for MIS−RP and 21.0% for ORP). PLND was not associated with a higher risk of DVT (OR 0.99; p= 0.98) or PE (OR 1.02; p= 0.91). However, PLND was associated with a higher risk of superficial surgical site infection (OR 1.68; p = 0.013), organ space surgical site infection (OR 1.77; p = 0.02), and perioperative transfusion (OR 1.32; p = 0.002) regardless of surgical approach. PLND was not associated with overall or major AEs on multivariable analysis. ORP was associated with a significantly higher risk of overall (OR 4.64, p &lt; 0.0001) and major (OR 1.6, p = 0.0004) AEs compared to MIS−RP. Conclusions: PLND during RP is associated with a significantly increased risk of certain types of AEs within the 30−day post−operative period. However, there appears to be no significant association between PLND and thromboembolic AEs. </jats:p

Perioperative outcomes of open and minimally invasive nephroureterectomy and pre-operative predictors of complications: An analysis using the National Surgical Quality Improvement Program database

408 Background: Minimally invasive nephroureterectomy (MINU) is an alternative approach to open nephroureterectomy for management of upper tract urothelial carcinoma (UTUC). Oncological outcomes between the two methods has been shown to be similar. We analyzed the NSQIP database to determine if there was a significant difference in perioperative complications between MINU and open nephroureterectomy. Methods: Between 2005 and 2013, a total of 1,027 patients were identified in the National Surgical Quality Improvement Program Database (NSQIP) that underwent nephrouretectomy for UTUC. Pre−operative covariates were analyzed to predict the rates of severe (Clavien−Dindo grade ≥ 3) perioperative complications. Univariate and multivariate logistic regression models (controlling for demographic and comorbid conditions) were built to predict severe complications and exploratory analyses were done to predict 18 common complications. Results: A total of 669 (65%) and 359 (35%) patients underwent MINU and open nephroureterectomy, respectively. Open nephroureterectomy was associated with a higher rate of severe complications (OR 1.87, CI 1.02−3.4, p = 0.04). Post−operative occurrence of pneumonia (OR 4.5, CI 1.7−3.4, p < 0.001) and transfusions (OR 2.5, CI 1.7−3.6, p < 0.0001) were lower for MINU compared to open nephroureterectomy. There were no significant differences between the two surgical methods with respect to incidence of other complications. MINU took longer on average than open nephroureterectomy (median 219 mins vs. 200 mins, p < 0.001). Time to discharge was longer for open nephroureterectomy compared to MINU (median 6.25 days vs. 5 days, p < 0.0001). Conclusions: Post−operative pneumonia and occurrence of severe complications (Clavien−Dindo grade ≥ 3) were higher for the open nephroureterectomy group compared to MINU. These data suggest that MINU is an acceptable surgical approach for management of UTUC that is associated with lower morbidity compared to open nephroureterectomy

Perioperative outcomes and complication predictors associated with open and minimally invasive nephroureterectomy

Minimally invasive nephroureterectomy (MINU) and open nephroureterectomy (ONU) have similar oncological outcomes for treatment of upper tract urothelial carcinoma (UTUC). We investigated perioperative outcomes and predictors of complications associated with MINU and ONU