The impact of resident involvement in minimally-invasive urologic oncology procedures
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The impact of resident involvement in minimally-invasive urologic oncology procedures. / Ruhotina, Nedim; Dagenais, Julien; Gandaglia, Giorgio; Sood, Akshay; Abdollah, Firas; Chang, Steven L; Leow, Jeffrey J; Olugbade, Kola; Rai, Arun; Sammon, Jesse D; Schmid, Marianne; Varda, Briony; Zorn, Kevin C; Menon, Mani; Kibel, Adam S; Trinh, Quoc-Dien.
In: CUAJ-CAN UROL ASSOC, Vol. 8, No. 9-10, 01.10.2014, p. 334-340.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - The impact of resident involvement in minimally-invasive urologic oncology procedures
AU - Ruhotina, Nedim
AU - Dagenais, Julien
AU - Gandaglia, Giorgio
AU - Sood, Akshay
AU - Abdollah, Firas
AU - Chang, Steven L
AU - Leow, Jeffrey J
AU - Olugbade, Kola
AU - Rai, Arun
AU - Sammon, Jesse D
AU - Schmid, Marianne
AU - Varda, Briony
AU - Zorn, Kevin C
AU - Menon, Mani
AU - Kibel, Adam S
AU - Trinh, Quoc-Dien
PY - 2014/10/1
Y1 - 2014/10/1
N2 - INTRODUCTION: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database.METHODS: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005-2011), we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates.RESULTS: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic).CONCLUSIONS: Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.
AB - INTRODUCTION: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database.METHODS: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005-2011), we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates.RESULTS: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic).CONCLUSIONS: Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.
U2 - 10.5489/cuaj.2170
DO - 10.5489/cuaj.2170
M3 - SCORING: Journal article
C2 - 25408800
VL - 8
SP - 334
EP - 340
JO - CUAJ-CAN UROL ASSOC
JF - CUAJ-CAN UROL ASSOC
SN - 1911-6470
IS - 9-10
ER -