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Kanji FF, Choi E, Dallas KB, Avenido R, Jamnagerwalla J, Pannell S, Eilber K, Catchpole K, Cohen TN, Anger JT. The impact of resident training on robotic operative times: is there a July Effect? J Robot Surg 2024; 18:208. [PMID: 38727857 PMCID: PMC11087355 DOI: 10.1007/s11701-024-01929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 05/13/2024]
Abstract
It is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019. Univariate and multivariate mix model analyses were performed to determine the association between operative time and patient age, estimated blood loss, case complexity, robotic surgical system (Si or Xi), and time of the academic year. Differences in surgery time and non-surgery time were assessed with/without resident presence. Operative time intervals were included in the analysis. Resident presence correlated with increased surgery time (38.6 min (p < 0.001)) and decreased non-surgery time (4.6 min (p < 0.001)). Surgery time involving residents decreased by 8.7 min after 4 months into the academic year (July-October), and by an additional 5.1 min after the next 4 months (p = 0.027, < 0.001). When compared across case types stratified by complexity, surgery time for cases with residents significantly varied. Cases without residents did not demonstrate such variability. Resident presence was associated with prolonged surgery time, with the largest effect occurring in the first 4 months and shortening later in the year. However, resident presence was associated with significantly reduced non-surgery time. These results help to understand how new trainees impact operating room times.
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Affiliation(s)
- Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eunice Choi
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kai B Dallas
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, Lancaster, CA, USA
| | - Raymund Avenido
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Urology, University of California, San Diego, 9400 Campus Point Drive, #7897, La Jolla, CA, 92037, USA.
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Wu SC, Swanton AR, Jones JM, Gross MS. New findings regarding the influence of assistants on surgical outcomes in penile prosthesis implantation. Int J Impot Res 2023; 35:736-740. [PMID: 36209303 DOI: 10.1038/s41443-022-00624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation is the definitive treatment for refractory erectile dysfunction, yet exposure to this procedure during training of urology residents is often limited. To assess the effects of resident participation in penile prosthesis surgery, we compared surgical outcomes in a retrospective case series of 253 penile prosthesis surgeries by a single surgeon at the same institution between 2017 and 2020 with the assistance of either a registered nurse first assistant (RNFA) or a resident. Pertinent patient characteristics and surgical complications including device complications, surgical site infection, postoperative bleeding, iatrogenic injury, cardiovascular events, pulmonary events, and urinary retention were documented. Measured outcomes included operative time, Emergency Room (ER) visits, unplanned postoperative visits, pain medication refills, and surgical complications. Compared to RFNAs, resident-assisted penile prosthesis surgery was associated with significant increase in mean operative time (71.4 min vs. 87.9 min, p < 0.01) and postoperative ER visits (3.0% vs. 10.6%, p = 0.03) but not surgical complications (19.7% vs. 20.8%, OR 1.03, 95% CI [0.46 -2.30]) or other measured outcomes. Compared to a dedicated RFNA, Resident assistance increased operative time by approximately 17 min, but did not increase post-operative surgical complications, supporting the notion that resident assistance in these procedures may be appropriate as an integral part of training.
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Affiliation(s)
- Shuo-Chieh Wu
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Amanda R Swanton
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James M Jones
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Nguyen AT, Anjaria DJ, Sadeghi-Nejad H. Advancing Urology Resident Surgical Autonomy. Curr Urol Rep 2023; 24:253-260. [PMID: 36917339 PMCID: PMC10011787 DOI: 10.1007/s11934-023-01152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE OF REVIEW This paper aims to survey current literature on urologic graduate medical education focusing on surgical autonomy. RECENT FINDINGS Affording appropriate levels of surgical autonomy has a key role in the education of urologic trainees and perceived preparedness for independent practice. Recent studies in surgical resident autonomy have demonstrated a reduction in autonomy for trainees in recent years. Efforts to advance the state of modern surgical training include creation of targeted curricula, enhanced with use of surgical simulation, and structured feedback. Decline in surgical autonomy for urology residents may influence confidence after completion of their residency. Further study is needed into the declining levels of urology resident autonomy, how it affects urologists entering independent practice, and what interventions can advance autonomy in modern urologic training.
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Affiliation(s)
- Anh T Nguyen
- Division of Urology Rutgers New Jersey Medical School, Newark, NJ, 07103, USA.
| | - Devashish J Anjaria
- East Orange Department of Surgery, Veteran Affairs New Jersey Healthcare System East Orange, East Orange, NJ, USA
| | - Hossein Sadeghi-Nejad
- East Orange Department of Surgery, Veteran Affairs New Jersey Healthcare System East Orange, East Orange, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
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Tsivian M, Bole R, Packiam VT, Boorjian SA, Thapa P, Frank I, Tollefson MK. The Association of Trainee Involvement in Radical Cystectomy With Perioperative and Oncologic Outcomes. Urology 2022; 165:128-133. [PMID: 35038487 DOI: 10.1016/j.urology.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/07/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the impact of trainee involvement in surgery on perioperative and oncological outcomes of patients undergoing radical cystectomy (RC). MATERIALS AND METHODS We reviewed the records of patients undergoing RC for urothelial carcinoma between 2000 and 2015 at our institution. Trainee level was categorized as fellow, chief, senior and junior residents. Demographic, perioperative and oncological outcomes were recorded and compared between the groups. Specifically, operative time, 30-day complications, severe complications (Clavien III-V) and oncological outcomes (overall, cancer-specific and recurrence-free survival) were assessed. RESULTS A total of 895 patients were included for study. On multivariable analysis, operative times were 30-40 minutes longer in procedures assisted by junior residents as compared to more senior trainees. Notably, trainee level was not associated with overall or severe complications on multivariable analyses. Similarly, trainee level was not associated with oncologic outcomes. CONCLUSION While cases assisted by junior residents had longer operative times, complication rates and oncological outcomes were comparable across trainee groups. Trainee level does not appear to have an impact on perioperative and oncological outcomes of RC for urothelial carcinoma.
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Affiliation(s)
| | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN.
| | | | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Mukkala AN, Song JB, Lee M, Boasie A, Irish J, Finelli A, Wei AC. A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer. Can Urol Assoc J 2021; 15:E531-E544. [PMID: 33750517 PMCID: PMC8525525 DOI: 10.5489/cuaj.6931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Unplanned visits (UPV) - re-admissions and emergency room (ER) visits - are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP to inform evidence-based quality improvement (QI) initiatives. METHODS A systematic review was performed for studies from 2000-2020 using keywords: "re-admission," "emergency room/department," "unplanned visit," and "prostatectomy." Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. RESULTS Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (approximately 5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6-24%; re-admissions range 0-56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications, such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common re-admission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urine-related issues, such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: open RP, lymph node dissection, Charlson comorbidity index ≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls, with odds ratio 0.62 (95% confidence interval 0.46-0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. CONCLUSIONS Twenty years of international, retrospective experience suggests UPV after RP are often related to GU complications and infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have the potential to reduce UPV after RP.
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Affiliation(s)
- Avinash N. Mukkala
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jasmine B. Song
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Lee
- Regional Cancer Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alexandra Boasie
- Surgery and Critical Care Program, University Health Network, Toronto, ON, Canada
| | - Jonathan Irish
- Surgical Oncology Program, Cancer Care Ontario, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alice C. Wei
- Surgical Oncology Program, Cancer Care Ontario, Toronto, ON, Canada
- Weill-Cornell School of Medicine, Cornell University, New York, NY, United States
- Sloan Kettering Cancer Center, New York, NY, United States
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[Exacerbation of working conditions due to the economic pressures of hospitals : Mandatory staffing ratios for physicians?]. Urologe A 2021; 60:1013-1018. [PMID: 34142170 PMCID: PMC8210964 DOI: 10.1007/s00120-021-01560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/07/2022]
Abstract
Hintergrund In der aktuellen stationären urologischen Versorgung sind ökonomischer Druck sowie dessen Einfluss auf die urologische Arbeits- und Weiterbildungsbedingungen ein Hauptkritikpunkt junger Urolog*innen. Vor dem Hintergrund eines wachsenden Nachwuchsbedarfs in unserer Fachdisziplin zeichnet sich somit ein dringender Handlungsbedarf ab. Mit der Einführung der Pflegepersonaluntergrenzen droht nun der Abbau von ärztlichem Personal mit dem Ziel einer betriebswirtschaftlich bedingten Kostenreduktion. Ziel der Arbeit Ein verpflichtender Personalschlüssel wird häufig genannt um dem Personalabbau in deutschen Klinken entgegenzuwirken. Welche Rolle die Personaluntergrenze hierbei spielt wird im folgenden Artikel erläutert. Material und Methoden Wir analysierten die aktuellen Gesetzesentwürfe der Bundesregierung, sowie Positionspapiere und Stellungnahmen bundespolitischer Vertreter wie dem Marburger Bund, Bundesverband Deutscher Urologen und der Bundesärztekammer seit dem Jahr 2018. Ergebnis und Diskussion Die Analyse der aktuellen Entwicklungen in der Pflegepolitik zeigt auf, dass als erster Schritt eine bedarfsorientierte Personalbemessung und anschließende Finanzierung im stationären Rahmen unerlässlich ist. Mit der adäquaten Personalbemessung wie im Ampelschema Bundesärztekammer würden sich nicht nur Kliniken als attraktive Arbeitgeber und Weiterbildungsstätten für große Teile der urologischen Ärzteschaft positionieren, sondern auch maßgeblich eine Verbesserung von Arbeitsbedingungen, Patientenversorgung und Patientensicherheit erwirken. Ärztliche Weiterbildung muss weiterhin essenzieller Teil des Klinikalltags bleiben.
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Dickinson KJ, Bass BL, Nguyen DT, Graviss EA, Pei KY. Public Perception of General Surgery Resident Autonomy and Supervision. J Am Coll Surg 2020; 232:8-15.e1. [PMID: 33022397 DOI: 10.1016/j.jamcollsurg.2020.08.764] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/03/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite patients being important stakeholders in surgical training, little is known about the public's perception of trainee participation in surgical care. This study evaluates the public's perception of surgical resident autonomy and supervision. STUDY DESIGN An anonymous electronic survey was sent to adult panelists older than 18 years in the US using SurveyGizmo. The design of the survey used Dillman's Tailored Design Method to optimize response rate. Participants completed surveys including demographic characteristics and perceptions toward general surgery resident autonomy. Univariable and multivariable analyses were used as appropriate. RESULTS Survey response rate was 93% (2,005 of 2,148). Demographic characteristics including age, gender, race or ethnicity, and highest level of education were nationally representative. Most respondents (87%) had health insurance. On multivariable logistic regression analysis, factors associated with participants who would never allow a resident to perform any portion of the operation include: female gender (odds ratio [OR] 1.58; 95% CI, 1.28 to 1.95), no health insurance (OR 1.38; 95% CI, 1.03 to 1.84), Black race (OR 1.82; 95% CI, 1.38 to 2.41), and Hispanic ethnicity (OR 1.49; 95% CI, 1.03 to 2.15). Participants who were younger than 50 years (OR 1.57; 95% CI, 1.24 to 1.98), male (OR 1.90; 95% CI, 1.56 to 2.32), of Black race (OR 1.45; 95% CI, 0.10 to 1.91), Hispanic ethnicity (OR 1.49; 95% CI, 1.05 to 2.11), working in healthcare (OR 2.18; 95% CI, 1.67 to 2.86), or insured (OR 1.46; 95% CI, 1.07 to 1.99) were more likely to believe that resident involvement increases complications. CONCLUSIONS Among survey participants broadly representing the US population, resident participation in operations is not universally accepted. Public perception of surgical resident autonomy and supervision is important, as GME continues to evolve to address readiness for independent practice.
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Affiliation(s)
| | - Barbara L Bass
- George Washington University School of Medicine and Health Services, Washington, DC
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Kevin Y Pei
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, IN
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Zeuschner P, Meyer I, Siemer S, Stoeckle M, Wagenpfeil G, Wagenpfeil S, Saar M, Janssen M. Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis. Ann Surg Oncol 2020; 28:1254-1261. [PMID: 32710272 PMCID: PMC7801306 DOI: 10.1245/s10434-020-08856-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/15/2020] [Indexed: 01/20/2023]
Abstract
Background Robot-assisted partial nephrectomy (RAPN) has become widely accepted, but its different underlying types of learning curves have not been comparatively analyzed to date. This study aimed to determine and compare the impact that the learning curve of the department, the console surgeon, and the bedside assistant as well as patient-related factors has on the perioperative outcomes of RAPN. Methods The study retrospectively analyzed 500 consecutive transperitoneal RAPNs (2007–2018) performed in a tertiary referral center by 7 surgeons and 37 bedside assistants. Patient characteristics and surgical data were obtained. Experience (EXP) was defined as the current number of RAPNs performed by the department, the surgeon, and the assistant. As the primary outcome, the impact of EXP and patient-related factors on perioperative outcomes were analyzed and compared. As the secondary outcome, a cutoff between “experienced” and “inexperienced” was defined. Correlation and regression analysis, receiver operating characteristic curve analysis, Fisher’s exact test, and the Mann–Whitney U test were performed, with p values lower than 0.05 denoting significance. Results The EXP of the department, the surgeon, and the assistant each has a major influence on perioperative outcome in RAPN irrespective of patient-related factors. Perioperative outcomes improve significantly with EXP greater than 100 for the department, EXP greater than 35 for the surgeon, and EXP greater than 15 for the assistant. Conclusions The perioperative results of RAPN are influenced by three different types of learning curves including those for the surgical department, the console surgeon, and the assistant. The influence of the bedside assistant clearly has been underestimated to date because it has a significant impact on the perioperative outcomes of RAPN. Electronic supplementary material The online version of this article (10.1245/s10434-020-08856-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Irmengard Meyer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stoeckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Martin Janssen
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany. .,Department of Urology and Pediatric Urology, University Hospital of Munster, Münster, Germany.
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Chen A, Ghodoussipour S, Titus MB, Nguyen JH, Chen J, Ma R, Hung AJ. Comparison of clinical outcomes and automated performance metrics in robot-assisted radical prostatectomy with and without trainee involvement. World J Urol 2019; 38:1615-1621. [PMID: 31728671 DOI: 10.1007/s00345-019-03010-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In this study, we investigate the effect of trainee involvement on surgical performance, as measured by automated performance metrics (APMs), and outcomes after robot-assisted radical prostatectomy (RARP). METHODS We compared APMs (instrument tracking, EndoWrist® articulation, and system events data) and clinical outcomes for cases with varying resident involvement. Four of 12 standardized RARP steps were designated critical ("cardinal") steps. Comparison 1: cases where the attending surgeon performed all four cardinal steps (Group A) and cases where a trainee was involved in at least one cardinal step (Group B). Comparison 2, where Group A is split into Groups C and D: cases where attending performs the whole case (Group C) vs. cases where a trainee performed at least one non-cardinal step (Group D). Mann-Whitney U and Chi-squared tests were used for comparisons. RESULTS Comparison 1 showed significant differences in APM profiles including camera movement time, third instrument usage, dominant instrument moving time, velocity, articulation, as well as non-dominant instrument moving time and articulation (all favoring Group A p < 0.05). There was a significant difference in re-admission rates (10.9% in Group A vs 0% in Group B, p < 0.02), but not for post-operative outcomes. Comparison 2 demonstrated a significant difference in dominant instrument articulation (p < 0.05) but not in post-operative outcomes. CONCLUSIONS Trainee involvement in RARP is safe. The degree of trainee involvement does not significantly affect major clinical outcomes. APM profiles are less efficient when trainees perform at least one cardinal step but not during non-cardinal steps.
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Affiliation(s)
- Andrew Chen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Saum Ghodoussipour
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Micha B Titus
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Jessica H Nguyen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Jian Chen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Runzhuo Ma
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA
| | - Andrew J Hung
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90033, USA.
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10
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König J, Aeishen S, Cebulla A, Bellut L, Fassbach M, Westphal J, Struck JP. Qualität statt Quantität verbessert die Weiterbildung. Urologe A 2019; 58:877-880. [DOI: 10.1007/s00120-019-0987-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baber J, Staff I, McLaughlin T, Tortora J, Champagne A, Gangakhedkar A, Pinto K, Wagner J. Impact of Urology Resident Involvement on intraoperative, Long-Term Oncologic and Functional Outcomes of Robotic Assisted Laparoscopic Radical Prostatectomy. Urology 2019; 132:43-48. [PMID: 31228477 DOI: 10.1016/j.urology.2019.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the impact of resident involvement in robot assisted laparoscopic prostatectomy on oncologic, functional, and intraoperative outcomes, both short and long term. METHODS We queried our prospectively maintained database of prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy from November 20, 2007 to December 27, 2016. We analyzed cases performed by 1 surgeon on a specific day of the week when the morning case involved at least 1 resident (R) and the afternoon case involved the attending physician only (nonresident [NR]). We compared R versus NR on a number of clinical, perioperative, and oncological outcomes. RESULTS A total of 230 NR and 230 R cases met inclusion criteria and were included in the analysis. Over one third (36.7%) of the NR group was Gleason 4+3 (Grade Group 3) or higher, relative to 25.9% of the R group, P = .015. Median operative time (OT) was significantly longer for R versus NR (200 minutes versus 156 minutes, P<.001) as was robotic time (161 minutes versus119 minutes, P<.001). No significant differences were noted for any other measure. Median follow-up for oncological outcomes was 30 and 33.5 months for NR and R, respectively (P= .3). Median OT and median estimated blood loss were both significantly greater in later years relative to the earlier years for R (2012-2016 versus 2007-2011; P< .001 for OT; P= .041 for median estimated blood loss) but not for NR. CONCLUSION Neither safety nor quality is diminished by R involvement in robot assisted laparoscopic prostatectomy.
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Affiliation(s)
- Jacob Baber
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Alison Champagne
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT
| | - Akshay Gangakhedkar
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT
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12
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Ourian AJ, Doval AF, Zavlin D, Chegireddy V, Echo A. Evaluating Patient Outcomes in Breast and Abdominal Cosmetic Plastic Surgery Procedures Involving Residents. Aesthet Surg J 2019; 39:572-578. [PMID: 30561504 DOI: 10.1093/asj/sjy329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hands-on training and exposure to cosmetic surgery is an integral part of plastic surgery residency. However, resident participation in cosmetic surgical cases is often limited in many training programs. Furthermore, the effect of resident participation in cosmetic surgery is poorly defined. OBJECTIVES The aim of this study was to analyze the impact of resident involvement on outcomes in cosmetic plastic surgery procedures, with a focus on breast and abdominal surgeries. METHODS A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed to identify all patients undergoing cosmetic breast and abdominal surgical procedures by plastic surgeons over a 4-year period (2009-2012). Multivariate regression models were constructed to determine any association between resident participation and surgical outcomes. RESULTS A total of 6982 patients were included in the analysis. Cases with resident involvement had higher rates of superficial surgical site infection (P < 0.0001), wound dehiscence (P = 0.014), and an increase in mean length of hospital stay (P = 0.001). Multivariate analysis revealed that the increased rate of superficial surgical site infection was associated with a higher body mass index and with the involvement of a resident during the surgical procedure. CONCLUSIONS This study provides further evidence to support the claim that resident involvement in cosmetic surgery is safe, with little effect on the rates of major complications. Any increase in minor complication rates must be critically analyzed with respect to the valuable surgical experience gathered by the next generation of surgeons. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Ariel J Ourian
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Andres F Doval
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Vishwanath Chegireddy
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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Dagenais J, Bertolo R, Garisto J, Maurice MJ, Mouracade P, Kara O, Chavali J, Li J, Nelson R, Fergany A, Abouassaly R, Kaouk JH. Variability in Partial Nephrectomy Outcomes: Does Your Surgeon Matter? Eur Urol 2019; 75:628-634. [DOI: 10.1016/j.eururo.2018.10.046] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022]
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McAbee KE, Pearlman AM, Terlecki RP. Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training. Investig Clin Urol 2018; 59:342-347. [PMID: 30182080 PMCID: PMC6121020 DOI: 10.4111/icu.2018.59.5.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 01/09/2023] Open
Abstract
Purpose Primary care providers harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Rates of infection following surgery for primary placement and revision are estimated as 1% to 3% and 10% to 18%, respectively. Our objective was to determine the contemporary incidence of infection following inflatable penile prostheses surgery at an academic training center where surgeons-in-training are routinely involved. Materials and Methods Review of a prospectively collected single-surgeon database was performed. All cases of inflatable penile prostheses placement from January 2011 through June 2017 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery. Results Three hundred nine cases meeting inclusion criteria were identified. Mean patient age was 64.2 years, and mean follow-up was 28.7 months. Distribution involved 257 (83.2%) for primary placement, 45 (14.6%) for removal/replacement, and 7 (2.3%) in setting of prior device removal. Diabetes was noted in 31.1% of men. Surgeon-in-training involvement was noted in 100% of cases. Infection was confirmed in a patient who had skin breakdown over an area of corporal reconstruction with polytetrafluoroethylene. The overall postoperative infection rate was 0.3%. Conclusions In this series from an academic training center, infection following penile prosthetic surgery is low, similar to other centers of excellence, even with 100% involvement of surgeons-in-training. This data should be used to better inform primary care providers and members of the general public potentially interested in restoration of sexual function.
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Affiliation(s)
- Kara E. McAbee
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Amy M. Pearlman
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ryan P. Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Nocera NF, Pyfer BJ, De La Cruz LM, Chatterjee A, Thiruchelvam PT, Fisher CS. NSQIP Analysis of Axillary Lymph Node Dissection Rates for Breast Cancer: Implications for Resident and Fellow Participation. JOURNAL OF SURGICAL EDUCATION 2018; 75:1281-1286. [PMID: 29605705 DOI: 10.1016/j.jsurg.2018.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/11/2018] [Accepted: 02/25/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Management of the axilla in invasive breast cancer (IBC) has shifted away from more radical surgery such as axillary lymph node dissection (ALND), towards less invasive procedures, such as sentinel lymph node biopsy. Because of this shift, we hypothesize that there has been a national downward trend in ALND procedures, subsequently impacting surgical trainee exposure to this procedure using the ACS-NSQIP database to evaluate this. METHODS Women with IBC were identified in the ACS-NSQIP database from 2007 to 2014. Procedures including ALND were identified using CPT codes. This number was divided by total cases, given a varying number of participating institutions each year. Next, cases involving resident participation were identified and divided by training level: junior (post graduate year-[PGY] 1-2), senior (PGY 3-5) and fellow (PGY ≥ 6). Two tailed z tests were used to compare proportions, with significance determined when p < 0.05. RESULTS A total of 128,372 women were identified with IBC with 36,844 ALND. ALND rates decreased by an average of 2.43% yearly from 2007 to 2014. Resident participation significantly drops in 2011, from 49.3% before to 29.4% after (p < 0.01). Junior residents experienced a significant decrease in participation rate (43.3%-32.2%, p < 0.05). Senior residents and fellows experienced an upward trend in their participation, although not significant (51.2%-56.3%, p = 0.35, and 5.6%-11.6%, p = 0.056, respectively). CONCLUSIONS Using the ACS-NSQIP database, we demonstrate the downward trend in rate of ALND for IBC with subsequent decrease in resident participation. Junior residents experienced a significant decrease in their participation with no significant change for senior or fellow-level trainees. Awareness of this trend is important when creating future surgical curriculum changes for general surgery and fellowship training programs.
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Affiliation(s)
- Nadia F Nocera
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
| | - Bryan J Pyfer
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University Hospital, Durham, North Carolina
| | - Lucy M De La Cruz
- Comprehensive Breast Care Program, Jupiter Medical Center, Jupiter, Florida
| | | | - Paul T Thiruchelvam
- Department of Breast Surgery, Imperial College London, London, United Kingdom
| | - Carla S Fisher
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Gorelik M, Godelman S, Elkbuli A, Allen L, Boneva D, McKenney M. Can Residents Be Trained and Safety Maintained? JOURNAL OF SURGICAL EDUCATION 2018; 75:1-6. [PMID: 28676300 DOI: 10.1016/j.jsurg.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/16/2017] [Accepted: 06/10/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Teaching hospitals and faculty need to balance the educational mission for training residents with patient safety. There are no data studying the change in trauma patient outcomes before and after implementation of a surgical residency. The objective of this study was to compare trauma center outcomes before and after the advent of a surgical training program. We predicted that patient-centric outcome metrics would not be affected by the integration of surgical residents into trauma patient care. METHODS A retrospective review was performed using the Crimson Continuum of Care (CCC) dataset and the Trauma Injury Severity Scores (TRISS) for the year before implementation of a surgical residency, compared to the 6 months following initiation of the residency. Severity and risk-adjusted performance measures included mortality, readmissions, complications, and length of stay. Using TRISS, actual, and predicted mortality was compared. RESULTS There were 1535 trauma admissions to the acute Care Trauma Service the year before starting the residency, and 856 admissions for the 6 months following the implementation of the program. The demographics were similar between the 2 groups. There was no clinically significant difference in observed mortality after the initiation of a surgery residency, based on CCC dataset variables and TRISS datasets. There were also no significant differences in complications and readmission rates. CONCLUSIONS We found that initiating a surgical training program did not affect mortality rates or complications of trauma patients. Training of general surgery residents in a high-performing trauma center can be effectively implemented without compromising patient safety.
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Affiliation(s)
- Marina Gorelik
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
| | - Steven Godelman
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Lauren Allen
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
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Assessing the effort associated with teaching residents. J Plast Reconstr Aesthet Surg 2017; 70:1725-1731. [PMID: 28882492 DOI: 10.1016/j.bjps.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/08/2017] [Accepted: 07/26/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intraoperative resident education is an integral mission of academic medical centers and serves as the basis for training the next generation of surgeons. The actual effort associated with teaching residents is unknown as it pertains to additional operative time. Using a large validated multi-institutional dataset, this study aims to quantify the effect of having a resident present in common plastic surgery procedures on operative time. Future directions for developing standardized methods to record and report teaching time are proposed, which can help inform prospective studies. STUDY DESIGN The 2006-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify seven isolated plastic surgical procedures that were categorized based on resident involvement and supervision. Linear regression models were used to calculate the difference in operative time with respect to resident participation while controlling for patient and operative factors. RESULTS Resident involvement was associated with longer operative times for muscle flap trunk procedures (53 min, 95% CI = [25, 80], p-value = 0.0002) and breast reconstruction procedures with a latissimus dorsi flap (55 min, 95% CI = [22, 88], p-value = 0.001). For six of the seven surgeries evaluated, resident involvement was associated with longer operative times, as compared to no resident involvement. CONCLUSION Resident involvement is associated with an increase in operative time for certain plastic surgery procedures. This finding underscores the need for a mechanism to quantify the time and effort that the attending surgeons allocate toward intraoperative resident education. Further study is also necessary to determine the causal impact on patient care.
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Resident participation is not associated with postoperative adverse events, reoperation, or prolonged length of stay following craniotomy for brain tumor resection. J Neurooncol 2017; 135:613-619. [DOI: 10.1007/s11060-017-2614-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/20/2017] [Indexed: 12/21/2022]
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Rodríguez-Socarrás M, Gómez Rivas J, García-Sanz M, Pesquera L, Tortolero-Blanco L, Ciappara M, Melnick A, Colombo J, Patruno G, Serrano-Pascual Á, Bachiller-Burgos J, Cozar-Olmo J. Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey. Actas Urol Esp 2017; 41:391-399. [PMID: 28336202 DOI: 10.1016/j.acuro.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the actual state of medical-surgical activity and training for urology residents in Spain. MATERIAL AND METHOD We designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. RESULTS The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. CONCLUSIONS Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.
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The Effect of Resident Involvement on Postoperative Short-Term Surgical Outcomes in Immediate Breast Reconstruction. Plast Reconstr Surg 2017; 139:1325-1334. [DOI: 10.1097/prs.0000000000003346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Khene ZE, Peyronnet B, Bosquet E, Pradère B, Robert C, Fardoun T, Kammerer-Jacquet SF, Verhoest G, Rioux-Leclercq N, Mathieu R, Bensalah K. Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy? BJU Int 2017; 120:591-599. [DOI: 10.1111/bju.13901] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Benoit Peyronnet
- Department of Urology; Rennes University Hospital; Rennes France
| | - Elise Bosquet
- Department of Urology; Rennes University Hospital; Rennes France
| | - Benjamin Pradère
- Department of Urology; Rennes University Hospital; Rennes France
| | - Corentin Robert
- Department of Radiology; Rennes University Hospital; Rennes France
| | - Tarek Fardoun
- Department of Urology; Rennes University Hospital; Rennes France
| | | | - Grégory Verhoest
- Department of Urology; Rennes University Hospital; Rennes France
| | | | - Romain Mathieu
- Department of Urology; Rennes University Hospital; Rennes France
| | - Karim Bensalah
- Department of Urology; Rennes University Hospital; Rennes France
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Baker AB, Ong AA, O'Connell BP, Sokohl AD, Clinkscales WB, Meyer TA. Impact of resident involvement in outpatient otolaryngology procedures: An analysis of 17,647 cases. Laryngoscope 2017; 127:2026-2032. [PMID: 28543359 DOI: 10.1002/lary.26645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 03/17/2017] [Accepted: 03/27/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examines the impact of resident physician participation on postoperative outcomes in outpatient otolaryngologic surgery. STUDY DESIGN Retrospective cohort. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for outpatient otolaryngologic procedures performed on adult patients. Cases were analyzed with the following cohorts: attending with resident or attending without resident. Outcomes included complications, readmission, reoperation, and operative time. RESULTS A total of 17,647 cases were analyzed, with 13,123 patients in the attending without resident cohort and 4,524 patients in the attending with resident cohort. The majority of patients were female (58.7%) and white (88.0%). The average age was 44 (range 16-89) years, and average body mass index was 29.0 ± 7.3 kg/m2 . Total relative value units were higher in the attending with resident group 14.6 ± 12.0 compared with 10.2 ± 8.3 in the attending without resident group (P < 0.01). Univariate analysis revealed that resident participation increased complication rate (2.0% vs. 1.4%, P < 0.01) and operative time (108 ± 98 minutes vs. 60 ± 55 minutes, P < 0.01). There were no differences in readmissions (P = 0.35), reoperations (P > 0.05), or death rates (P = 0.32) between groups. Multivariate regression analysis, however, revealed that resident participation did not increase the rate of any complication, and that operative time was the only significantly impacted variable (P < 0.01). CONCLUSION Resident surgical training remains a vital component of the current health care system. Previous research has shown that, despite increased operative time, resident participation does not significantly impact complication rates for otolaryngology procedures. This study confirms these findings in the outpatient setting, thus reassuring both the surgeon and patients that resident participation does not impact procedural safety. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2026-2032, 2017.
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Affiliation(s)
- Andrew B Baker
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Adrian A Ong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Brendan P O'Connell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Alexander D Sokohl
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - William B Clinkscales
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Hamid KS, Nwachukwu BU, Bozic KJ. Decisions and Incisions: A Value-Driven Practice Framework for Academic Surgeons. J Bone Joint Surg Am 2017; 99:e50. [PMID: 28509834 DOI: 10.2106/jbjs.16.00818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kamran S Hamid
- 1Rush University Medical Center, Chicago, Illinois 2Hospital for Special Surgery, New York, NY 3Dell Medical School, The University of Texas at Austin, Austin, Texas
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Sharif-Afshar AR, Wood LN, Bresee C, Souders CP, Gross BS, Shkolyar E, Anger JT, Eilber KS. Teaching mid-urethral sling surgery to residents: Impact on operative time and postoperative outcomes. Neurourol Urodyn 2017; 36:2148-2152. [PMID: 28370305 DOI: 10.1002/nau.23259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/06/2017] [Indexed: 11/11/2022]
Abstract
AIMS The purpose of this study was to determine the impact of resident teaching on outcomes of mid-urethral sling surgery. METHODS A retrospective review of female patients who underwent an outpatient transobturator (TOT) synthetic mid-urethral sling procedure with and without concomitant prolapse repair by two surgeons (JA, KE) in a tertiary female pelvic medicine practice was performed. Total procedure time (TPT = time from incision to closure including sling placement and any prolapse procedure), estimated blood loss (EBL), and postoperative complications including urinary retention, mesh exposure, reoperation, vaginal bleeding, and leg pain were compared between cases with and without the presence of a resident. RESULTS One hundred thirty-four women underwent an outpatient transobturator sling procedure. Fifty-seven patients (43%) had a concomitant prolapse procedure. A resident was present at 57% (76/134) of cases. The average observed TPT (±SEM) was 60.6 ± 3.1 min when a resident was present and 46.6 ± 2.5 min when a resident was not present (P = 0.001). However, residents were more likely to be present when concomitant procedures were performed (P = 0.003). After adjusting for this, the presence of a resident increased TPT by an estimated 7.9 ± 2.5 min (P = 0.002). There was no statistical difference in EBL or postoperative complications. CONCLUSIONS Resident participation in transobturator sling procedures resulted in a statistically significant, although clinically small, increase in operative time and had no significant impact on EBL or postoperative complications.
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Affiliation(s)
- Ali-Reza Sharif-Afshar
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lauren N Wood
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Colby P Souders
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Bruno S Gross
- Texas A&M Health Science Center College of Medicine, Bryan, Texas
| | - Eugene Shkolyar
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer T Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karyn S Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes? Urol Oncol 2017; 35:227-233. [PMID: 28089074 DOI: 10.1016/j.urolonc.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Partial nephrectomy (PN) represents the treatment of choice for localized renal tumor<7cm. Minimally invasive approaches are considered standard of care in many institutions. Maintaining acceptable warm ischemic time (WIT) while teaching robotic PN (RPN) remains challenging. The goal of the present study was to assess the effect of teaching RPN on WIT and renal function in patients undergoing RPN. METHODS Patients undergoing RPN for cT1-T2 renal tumors were included. RENAL nephrometry score was used to adjust for tumor complexity. Glomerular filtration rates (GFR) were determined preoperatively, at day 2 and at ≥3-month follow-up. Patients in whom the attending surgeon (staff) performed tumorectomy and renorraphy were compared with those in whom the fellow performed these steps. Primary outcomes were WIT and GFR decrease at follow-up visit. Morbidity and margin positivity represented secondary outcomes. RESULTS Overall, 69 patients (46 "staff" vs. 23 "fellow") were included. Patient׳s characteristics did not differ significantly between the 2 groups. In particular, RENAL score and preoperative GFR were similar between both groups. Mean WIT was 22±9 in the staff and 24±7 in the fellow group (P = 0.09). At follow-up, a GFR reduction of 9% was observed in the staff group vs. 13% in the fellow group (P = 0.38). Complication rates (13% vs. 17%, P = 0.63) and positive margins (9% vs. 4%, P = 0.47) did not differ significantly between staff and fellow. CONCLUSIONS In our experience, teaching RPN with a strict supervision and stepwise standardized procedure was oncologically and functionally safe after 3 to 6 months of follow-up.
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Sippey M, Spaniolas K, Kasten KR. Elucidating Trainee Effect on Outcomes for General, Gynecologic, and Urologic Oncology Procedures. J INVEST SURG 2016; 30:359-367. [PMID: 27929699 DOI: 10.1080/08941939.2016.1255805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical complications delay adjuvant therapy in oncology patients. Current literature remains unclear regarding resident effect on postoperative outcomes, with inappropriate coverage possibly endangering patients in spite of attending oversight. We assessed resident postgraduate year (PGY) effect on 30-day overall morbidity in cancer patients undergoing major intra-abdominal and non-abdominal surgery. METHODS Patients undergoing non-emergent major intra- and extra-abdominal operations from 2005-2012 were queried using the American College of Surgeons' National Surgical Quality Improvement Program. Attending alone and resident PGY cohorts were compared for demographics, 30-day overall morbidity, mortality, and relevant outcomes. RESULTS A total of 156,941 cancer patients undergoing major intra-abdominal (n = 76,385) or major non-abdominal (n = 80,556) procedures were captured. Demographics were clinically similar across attending and PGY levels. Rates of overall morbidity increased significantly with PGY level, along with operative time and length of stay. For major intra-abdominal procedures, all resident levels except PGY2 level adversely affected overall morbidity. Above PGY4 level, resident involvement had a stronger association with adverse outcome than preoperative comorbidities and preoperative chemotherapy. Interestingly, gastric, gall bladder, liver, pancreas, esophageal, and thyroid procedures demonstrated no effect of resident involvement on overall morbidity. CONCLUSIONS Resident PGY is independently associated with increased overall morbidity in patients undergoing selected major surgical procedures. Understanding surgical procedures affected by resident involvement will maximize outcomes.
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Affiliation(s)
- Megan Sippey
- a Department of Surgery , Brody School of Medicine at East Carolina University , Greenville , North Carolina , USA
| | - Konstantinos Spaniolas
- a Department of Surgery , Brody School of Medicine at East Carolina University , Greenville , North Carolina , USA
| | - Kevin R Kasten
- b Department of Surgery , Carolinas Health Care System , Charlotte , North Carolina , USA
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Kshirsagar RS, Chandy Z, Mahboubi H, Verma SP. Does resident involvement in thyroid surgery lead to increased postoperative complications? Laryngoscope 2016; 127:1242-1246. [PMID: 27753090 DOI: 10.1002/lary.26176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/23/2016] [Accepted: 06/09/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of resident involvement during thyroid surgery on 30-day postoperative complications. STUDY DESIGN Retrospective cohort study. METHODS All patients who underwent thyroid surgery in 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, perioperative details, resident involvement in surgery, and 30-day postoperative complications were extracted. Propensity score analysis was used to match resident and nonresident cases. Univariate and multivariate analysis were performed to determine the relationship between resident involvement in thyroid surgery and postoperative outcomes. RESULTS One thousand seven hundred forty-seven patients with and 1,747 patients without resident involvement were case-matched for patient demographics, perioperative variables, and surgical case type. There was no significant difference (P = .19) in 30-day postoperative complication rates of surgeries with and without resident involvement, which were 1.4% and 2%, respectively. Operative time was longer in surgeries with residents than those without residents (119 ± 67 minutes vs. 102 ± 55 minutes, P < .001). Cases with resident involvement had an unplanned reoperation rate of 0.9%, which was significantly lower than the 2.3% rate of surgeries without residents (P = .001). Multivariate analysis revealed no significant association between resident involvement and overall complications (odds ratio = 0.70; P = .18). CONCLUSIONS Resident participation in thyroid surgery was not associated with an increased 30-day postoperative complication rate. These findings demonstrate that patient safety is not adversely affected by resident participation in thyroid surgery. LEVEL OF EVIDENCE 2C Laryngoscope, 127:1242-1246, 2017.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Zachariah Chandy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Hossein Mahboubi
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
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Welk B, Winick-Ng J, McClure A, Vinden C, Dave S, Pautler S. The impact of teaching on the duration of common urological operations. Can Urol Assoc J 2016; 10:172-178. [PMID: 27713793 DOI: 10.5489/cuaj.3737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals. METHODS We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002-2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume. RESULTS 114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10-21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres. CONCLUSIONS Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.
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Affiliation(s)
- Blayne Welk
- University of Western Ontario, London, ON, Canada;; Institute for Clinical Evaluative Sciences, London, ON, Canada
| | | | - Andrew McClure
- Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Chris Vinden
- University of Western Ontario, London, ON, Canada;; Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Sumit Dave
- University of Western Ontario, London, ON, Canada
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Massenburg BB, Sanati-Mehrizy P, Jablonka EM, Taub PJ. The Impact of Resident Participation in Outpatient Plastic Surgical Procedures. Aesthetic Plast Surg 2016; 40:584-91. [PMID: 27234526 DOI: 10.1007/s00266-016-0651-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Ensuring patient safety along with a complete surgical experience for residents is of utmost importance in plastic surgical training. The effect of resident participation on the outcomes of outpatient plastic surgery procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a prospective, validated, national database. METHODS We identified all outpatient procedures performed by plastic surgeons between 2007 and 2012 in the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models assessed the impact of resident participation when compared to attendings alone on 30-day wound complications, overall complications, and return to the operating room (OR). RESULTS A total of 18,641 patients were identified: 12,414 patients with an attending alone and 6227 with residents participating. The incidence of overall complications, wound complications, and return to OR was increased with resident participation. When confounding variables were controlled for in multivariate analysis, resident participation was no longer associated with increased risk of wound complications. When stratified by year, incidence of overall complications, wound complications, and return to OR in the resident participation group are trending down and fail to be significantly different in 2011 and 2012. Multivariate analysis shows a similar trend. CONCLUSIONS Resident participation is no longer independently associated with increased complications in outpatient plastic surgery in recent years, suggesting that plastic surgical training is successfully continuing to improve in both outcomes and safety. Additional prospective studies that characterize patient outcomes with resident seniority and the degree of resident participation are warranted. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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The Effect of Resident Involvement on Surgical Outcomes for Common Urologic Procedures: A Case Study of Uni- and Bilateral Hydrocele Repair. Urology 2016; 94:70-6. [DOI: 10.1016/j.urology.2016.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 11/18/2022]
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Cohen AJ, Brodie K, Murthy P, Wilcox DT, Gundeti MS. Comparative Outcomes and Perioperative Complications of Robotic Vs Open Cystoplasty and Complex Reconstructions. Urology 2016; 97:172-178. [PMID: 27443464 DOI: 10.1016/j.urology.2016.06.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare perioperative and surgical outcomes in a 2-center, 2-surgeon open vs robotic augmentation ileocystoplasty. MATERIALS AND METHODS We reviewed patients undergoing augmentation ileocystoplasty open vs robotically between 2008 and 2014 at 2 centers. We compared the groups' preoperative characteristics, perioperative outcomes, complications, and interim functional outcomes. RESULTS The cohort consisted of 17 and 15 patients with median follow-up of 45 and 46 months, in open and robotic groups, respectively. Median operative time (incision to closure) was longer in the robotic cohort (265 minutes vs 623 minutes, P < .001). Median length of stay (7 days vs 6 days, P = .335), time to diet (4 days vs 4 days, P = .125), and mean intravenous morphine equivalents/kg (1.23 mg/kg vs 0.56 mg/kg, P = .091) were comparable between groups for open and robotic, respectively. There were 4/17 (23.5%) of the open cohort who had an epidural for an average of 93 hours. All patients had stable or improved hydronephrosis postoperatively. Major reoperations, such as for bowel obstruction, were required in 2/17 (11.7%) in the open group and none in the robotic cohort. Minor stomal complications requiring skin-level revision or endoscopic procedure occurred in 4/17 (23.5%) in the robotic cohort and 2 (11.7%) in the open group. CONCLUSION We reveal equivalent rates of complications, length of stay, and blood loss for augmentation cystoplasty among appropriately matched controls. Prolonged operative times of the robotic cohort did not lead to additional morbidity for patients. Further steps to reduce morbidity and additional investigations should be undertaken prior to widespread adoption of the intracorporeal technique in experienced robotic centers.
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Affiliation(s)
- Andrew J Cohen
- Section of Urology, University of Chicago Medicine, Comer Children's Hospital, Chicago, IL.
| | | | - Prithvi Murthy
- Section of Urology, University of Chicago Medicine, Comer Children's Hospital, Chicago, IL
| | | | - Mohan S Gundeti
- Section of Urology, University of Chicago Medicine, Comer Children's Hospital, Chicago, IL
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Cocci A, Patruno G, Gandaglia G, Rizzo M, Esperto F, Parnanzini D, Pietropaolo A, Principi E, Talso M, Baldesi R, Battaglia A, Shehu E, Carrobbio F, Corsaro A, La Rocca R, Marchioni M, Bianchi L, Miglioranza E, Mantica G, Martorana E, Misuraca L, Fontana D, Forte S, Napoli G, Russo GI. Urology Residency Training in Italy: Results of the First National Survey. Eur Urol Focus 2016; 4:280-287. [PMID: 28753765 DOI: 10.1016/j.euf.2016.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/30/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology. OBJECTIVE To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure. DESIGN, SETTING, AND PARTICIPANTS A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction. RESULTS AND LIMITATIONS In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published ≤5, 38 (12%) ≤10, 26 (8%) ≤15, four (1%) ≤20, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p=0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p=0.02). CONCLUSIONS Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging. PATIENT SUMMARY In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giulio Patruno
- Department of Urology, Hospital Policlinico Tor Vergata, University of Roma Tor Vergata, Roma, Italy
| | - Giorgio Gandaglia
- Department of Urology, San Raffaele Hospital, University Vita Salute San Raffaele di Milano, Milano, Italy
| | - Michele Rizzo
- Department of Urology, Cattinara Hospital, University of Trieste, Italy
| | - Francesco Esperto
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Daniele Parnanzini
- Department of Urology, Santissima Trinità Hospital, University of Cagliari, Cagliari, Italy
| | - Amelia Pietropaolo
- Department of Urology, Hospital Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Emanuele Principi
- Department of Urology Ospedali riuniti di Ancona, University of Marche, Ancona, Italy
| | - Michele Talso
- Department of Urology, Hospital Maggiore Policlinico Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Ramona Baldesi
- Department of Urology, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Antonino Battaglia
- Department of Urology, Molinette hospital,University of Torino, Torino, Italy
| | - Ervin Shehu
- Department of Urology, Campus Biomedico Hospital, University Campus Biomedico, Rome, Italy
| | - Francesca Carrobbio
- Department of Urology, A.O. Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alfio Corsaro
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Roberto La Rocca
- Department of Urology, Policlinico Federico II Hospital, University Federico II of Naples, Naples, Italy
| | - Michele Marchioni
- Department of Urology, SS. Annunziata Hospital, University of Chieti, Chieti, Italy
| | - Lorenzo Bianchi
- Department of Urology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Eugenio Miglioranza
- Department of Urology, Gemelli Hospital, Cattolica University of Rome, Rome, Italy
| | - Guglielmo Mantica
- Department of Urology, San Martino Hospital, University of Genova, Genova, Italy
| | - Eugenio Martorana
- Department of Urology, Policlinico di Modena Hospital, University of Modena, Modena, Italy
| | - Leonardo Misuraca
- Department of Urology, Umberto I Hospital, University La Sapienza of Rome, Rome, Italy
| | - Dario Fontana
- Department of Urology, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - Saverio Forte
- Department of Urology, Policlinico di Bari Hospital, University of Bari, Bari, Italy
| | - Giancarlo Napoli
- Department of Urology, Policlinico G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy.
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Sippey M, Spaniolas K, Manwaring ML, Pofahl WE, Kasten KR. Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy. Am J Surg 2016; 211:1026-34. [DOI: 10.1016/j.amjsurg.2015.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 12/21/2022]
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Bos D, Allard CB, Dason S, Ruzhynsky V, Kapoor A, Shayegan B. Impact of resident involvement in endoscopic bladder cancer surgery on pathological outcomes. Scand J Urol 2016; 50:234-8. [PMID: 27045233 DOI: 10.3109/21681805.2016.1163616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Transurethral resection of bladder tumor (TURBT) pathology specimens which lack muscle are associated with clinical upstaging and may necessitate repeat resections, potentially delaying curative treatment. This study evaluated whether resident involvement in TURBT is associated with suboptimal perioperative outcomes. MATERIALS AND METHODS All TURBTs performed at a Canadian healthcare institution from November 2011 to June 2014 were reviewed. Multivariable logistic regression models assessed associations between intraoperative resident involvement and TURBT muscle presence. Among high-risk patients (high grade, ≥ T1 or carcinoma in situ) who underwent cystectomy, time from TURBT to cystectomy was compared between resident and attending urologists with the log-rank test. RESULTS In total, 463 TURBTs were identified. In multivariable analyses, residents were less likely to obtain muscle in specimens for all TURBTs [adjusted odds ratio (aOR) 0.59, p = 0.03] and the subset of 275 high-risk TURBTs (aOR 0.41, p = 0.006). Among patients who underwent cystectomy, time to cystectomy was delayed by a median of 23 days when residents were involved in the initial high-risk TURBT compared with attending urologists only (p = 0.024). CONCLUSIONS In this single academic center series, intraoperative resident involvement was associated with a decreased rate of muscle presence in TURBT specimens and a prolonged time to cystectomy.
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Affiliation(s)
- Derek Bos
- a McMaster University , Hamilton , ON , Canada
| | - Christopher B Allard
- a McMaster University , Hamilton , ON , Canada ;,b Massachusetts General Hospital , Boston , MA , USA ;,c Brigham and Women's Hospital , Boston , MA , USA
| | - Shawn Dason
- a McMaster University , Hamilton , ON , Canada
| | | | - Anil Kapoor
- a McMaster University , Hamilton , ON , Canada
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Potretzke AM, Knight BA, Brockman JA, Vetter J, Figenshau RS, Bhayani SB, Benway BM. The role of the assistant during robot-assisted partial nephrectomy: does experience matter? J Robot Surg 2016; 10:129-34. [PMID: 27039192 DOI: 10.1007/s11701-016-0582-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/19/2016] [Indexed: 01/12/2023]
Abstract
The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surgeons at our institution from April 2011 to September 2014. A senior-level assistant was defined as a resident in his or her post-graduate year (PGY) 4 or 5, or a fellow. Junior-level assistants were considered to be PGY-2, PGY-3, or a nurse first assistant. Multivariate analyses were performed using linear, Poisson, and logistic regression models. There were 115 junior-level cases and 299 senior-level cases. On univariate analysis, the experience level of the assistant had no impact on operative time (168 for junior level vs. 163 min for senior level, p = 0.656). Likewise, there were no differences between the junior- and senior-level groups with regard to warm ischemia time (21.3 vs. 20.9 min, p = 0.843), negative margin status (111/115 (96.5 %) vs. 280/299 (93.6 %), p = 0.340), or postoperative complications (17/115 (14.8 %) vs. 35/299 (11.7 %), p = 0.408). After multivariate analysis, operative time was associated with increased body mass index and tumor size (both p < 0.001), but not with resident experience level (p = 0.051). Estimated blood loss and postoperative complications were also not associated with the PGY of the assistant (p = 0.488 and p = 0.916, respectively). Despite common concern, the PGY status of a physician trainee serving as the bedside assistant does not appear to influence the outcomes of robot-assisted partial nephrectomy at a high-volume center.
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Affiliation(s)
- Aaron M Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
| | - Brent A Knight
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - John A Brockman
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Joel Vetter
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Brian M Benway
- Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Di Trapani E, Guillonneau B. The Role of Simulation in Surgical Training: An Analysis of Controversies. Eur Urol Focus 2016; 2:65-66. [PMID: 28723452 DOI: 10.1016/j.euf.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ettore Di Trapani
- Department of Urology, Diaconesses-Croix Saint-Simon Hospital, Paris, France; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Leow JJ, Chang SL, Meyer CP, Wang Y, Hanske J, Sammon JD, Cole AP, Preston MA, Dasgupta P, Menon M, Chung BI, Trinh QD. Robot-assisted Versus Open Radical Prostatectomy: A Contemporary Analysis of an All-payer Discharge Database. Eur Urol 2016; 70:837-845. [PMID: 26874806 DOI: 10.1016/j.eururo.2016.01.044] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy. OBJECTIVE To compare outcomes and costs between RARP and open RP (ORP). DESIGN, SETTING, AND PARTICIPANTS A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database. INTERVENTION RARP was ascertained through a review of the hospital charge description master for robotic supplies. OUTCOME MEASURES AND STATISTICAL ANALYSIS Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates. RESULTS AND LIMITATIONS RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study. CONCLUSIONS Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP. PATIENT SUMMARY In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.
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Affiliation(s)
- Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian P Meyer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian Hanske
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Jesse D Sammon
- VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prokar Dasgupta
- Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, UK
| | - Mani Menon
- VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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The effect of trainee involvement on perioperative outcomes of abdominal aortic aneurysm repair. J Vasc Surg 2016; 63:16-22. [DOI: 10.1016/j.jvs.2015.07.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022]
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Meyer CP, Salem J, Kluth LA, Sanatgar N, Borgmann H, Grange P, Chun F. Das GeSRU Endo-Training – Strategien zur Optimierung der endourologischen Ausbildung. Urologe A 2015; 55:253-6. [DOI: 10.1007/s00120-015-0015-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Allard CB, Meyer CP, Gandaglia G, Chang SL, Chun FKH, Gelpi-Hammerschmidt F, Hanske J, Kibel AS, Preston MA, Trinh QD. The Effect of Resident Involvement on Perioperative Outcomes in Transurethral Urologic Surgeries. JOURNAL OF SURGICAL EDUCATION 2015; 72:1018-1025. [PMID: 26003818 DOI: 10.1016/j.jsurg.2015.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To conduct the first study of intra- and postoperative outcomes related to intraoperative resident involvement in transurethral resection procedures for benign prostatic hyperplasia and bladder cancer in a large, multi-institutional database. DESIGN Relying on the American College of Surgeons National Surgical Quality Improvement Program Participant User Files (2005-2012), we abstracted all cases of endoscopic prostate surgery (EPS) for benign prostatic hyperplasia and transurethral resection of bladder tumors (TURBTs). Multivariable logistic regression models were constructed to assess the effect of trainee involvement (postgraduate year [PGY] 1-2: junior, PGY 3-4: senior, PGY ≥ 5: chief or fellow) vs attending only on operative time and length of hospital stay, as well as 30-day complication, reoperation, and readmission rates. RESULTS In all, 5093 EPS and 3059 TURBTs for a total of 8152 transurethral resection procedures were performed during the study period for which data on resident involvement were available. In multivariable analyses, resident involvement in EPS or TURBT was associated with increased odds of prolonged operative times and hospital readmissions in 30 days independent of resident level of training. Resident involvement was not associated with overall complications or reoperation rates. CONCLUSIONS Resident involvement in lower urinary tract surgeries is associated with increased readmissions. Strategies to optimize resident teaching of these common urologic procedures in order to minimize possible risks to patients should be explored.
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Affiliation(s)
- Christopher B Allard
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Urology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Christian P Meyer
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francisco Gelpi-Hammerschmidt
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Julian Hanske
- Center for Surgery and Public Health and Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts
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Meyer CP, Hanske J, Friedlander DF, Schmid M, Dahlem R, Trinh VQ, Chang SL, Kibel AS, Chun FK, Fisch M, Trinh QD, Eswara JR. The Impact of Resident Involvement in Male One-stage Anterior Urethroplasties. Urology 2015; 85:937-41. [DOI: 10.1016/j.urology.2015.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
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42
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[It starts with the novices: training curricula for robot-assisted surgery]. Urologe A 2015; 54:259-60. [PMID: 25637320 DOI: 10.1007/s00120-015-3766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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