Abstract: PD02-12
Sources of Funding: None.

Introduction

Conflicting evidence exists regarding the impact of resident involvement on surgical outcomes. The primary aim of this study is to assess the impact of resident involvement on perioperative complications in pelvic organ prolapse surgery using the National Surgical Quality Improvement Database (NSQIP).

Methods

The NSQIP database was queried from 2009 through the end of 2013 to identify all cases of pelvic organ prolapse repair using relevant Current Procedural Terminology (CPT) codes. This analysis included both urologic and gynecologic surgeons. We first stratified and analyzed this data by resident participation. To control for the effect of pre-operative comorbidity, propensity scores of resident involvement were calculated. The probability that any given case would be assigned to the “Resident Involvement� arm is represented on a scale of 0 to 1. To analyze cases according to similar probabilities, all cases were then divided into quartiles. Because the 25th and 50th quartiles were the same value (probability of 0.407), three groups were created (Q1/2, Q3, Q4). Stratification by resident involvement and comparision of perioperative outcomes were performed within each group. As a control, complications of transurethral resection of prostate (TURP) and nephrectomy (both total and partial) were stratified by resident involvement.

Results

We identified 2,644 cases that included resident participation. Across all groups, resident involvement was associated with increased post-operative urinary tract infections, overall perioperative complications and procedure length. Resident involvement in cases was without significant change with 481/1159 (41.5%) in 2009 to 685/1624 (42.2%) in 2010 to 598/1356 (44.1%) in 2011 and finally 595/1399 (42.5%) in 2012. In the first group, resident involvement was associated with increased readmissions, pulmonary embolism, and sepsis. In the second and third groups, resident involvement was associated with increased rates of superficial surgical site infection. Nephrectomy cases demonstrated similar outcomes. Resident involvement in TURP was associated only with increased procedure lengths and decreased post-operative length of stay.

Conclusions

Resident involvement in pelvic organ prolapse surgery was associated with an increased risk of adverse outcomes. A similar effect was seen with nephrectomy but not with a more simple endoscopic urologic procedure

Funding

None.