Abstract: PD58-09
Sources of Funding: none

Introduction

There has been increased focus on supervision and quality of care in resident education. Studies suggest trainee involvement in complex urologic procedures results in increased operative time with decreased complications. We wanted to examine the effects of trainee involvement in fundamental urology procedures.

Methods

Current Procedural Terminology codes were used to identify patients within the National Surgical Quality Improvement Program database who underwent a selection of fundamental general urology procedures (2005-2013). Operative time and perioperative complications (30-day) were examined and compared between cases with and without resident/fellow (R/F) involvement.

Results

29,488 patients had general urology procedures with information regarding trainee involvement, 13,251 (44.9%) with R/F involvement and 16,237 (55.1%) without. Overall patients who underwent procedures with trainee involvement were younger and had fewer comorbidities (table 1). R/F involvement showed significant increase in operative time in all procedures included in the study (table 2.) On multivariate analysis trainee involvement increased the risk of complications (OR 1.61, 95% CI 1.45-1.78, p<0.001). Other factors that increased the risk of complications were: ASA class 3-4 (OR 2.01, 95% CI 1.46-2.77, p<0.001), partially/totally dependent functional status (2.22, 95% CI 1.68-2.94, p<0.001), diabetes mellitus (OR 1.21, 95% CI 1.05-1.39, p=0.008), heart disease (OR 1.19, 95% CI 1.02-1.38, p=0.027), and respiratory disease (OR 1.33, 95% CI 1.09-1.63, p=0.027). Laparoscopic approach showed a decreased risk in complications (OR 0.44, 95% CI 0.39-0.49, p<0.001).

Conclusions

While R/F are valuable members of the urology team at teaching hospitals and training is necessary, their involvement in urologic surgery appears to increase operative time and complications. Further research needs to be done on how to mitigate these effects while preserving surgical education quality.

Funding

none