Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of minimally invasive abdominal sacrocolpopexy with resident operative involvement

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Resident involvement in complex surgeries is under scrutiny with increasing attention paid to health care efficiency and quality. Outcomes of urogynecological surgery with resident involvement are poorly described. We hypothesized that resident surgical involvement does not influence perioperative outcomes in minimally invasive abdominal sacrocolpopexy (ASC).

Methods

Using the 2006–2012 National Surgical Quality Improvement Program database, we identified 450 cases of laparoscopic or robotic ASC performed with resident involvement. Resident operative participation was stratified by experience (junior [PGY 1–3] vs senior level [PGY ≥4]). The primary outcome was operative time, and multinomial logistic regression was used to determine the effects of resident involvement and experience. Chi-squared analyses were used to assess the relationship between resident participation with length of stay (LOS) and 30-day complications and readmissions.

Results

Residents participated in 74% (n = 334) of these surgeries, and these cases were significantly longer (median 220 vs 195 min, p = 0.03). On multivariate analysis, senior level resident involvement was associated with longer operative times across all time intervals compared with <2 h (2 to ≤4 h relative risk reduction [RRR] 4.1, p = 0.007, CI 1.47–11.40; 4 to ≤6 h RRR 6.6, p = 0.001, CI 2.23–19.44; ≥6 h RRR 4.7, p = 0.020, CI 1.28–17.43). Resident participation was not associated with LOS, readmissions, or complications.

Conclusions

Senior level resident involvement in minimally invasive ASC is associated with longer operative times, with no association with LOS or adverse perioperative outcomes. The educational benefit of surgical training does not adversely affect patient outcomes for ASC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Iglehart JK. Revisiting duty-hour limits—IOM recommendations for patient safety and resident education. N Engl J Med. 2008;359(25):2633–5. https://doi.org/10.1056/NEJMp0808736.

    Article  CAS  PubMed  Google Scholar 

  2. Ferraris VA, Harris JW, Martin JT, Saha SP, Endean ED. Impact of residents on surgical outcomes in high-complexity procedures. J Am Coll Surg. 2016;222(4):545–55. https://doi.org/10.1016/j.jamcollsurg.2015.12.056.

    Article  PubMed  Google Scholar 

  3. Castleberry AW, Clary BM, Migaly J, Worni M, Ferranti JM, Pappas TN, et al. Resident education in the era of patient safety: a nationwide analysis of outcomes and complications in resident-assisted oncologic surgery. Ann Surg Oncol. 2013;20(12):3715–24. https://doi.org/10.1245/s10434-013-3079-2.

    Article  Google Scholar 

  4. Matulewicz RS, Pilecki M, Rambachan A, Kim JY, Kundu SD. Impact of resident involvement on urological surgery outcomes: an analysis of 40,000 patients from the ACS NSQIP database. J Urol. 2014;192(3):885–90. https://doi.org/10.1016/j.juro.2014.03.096.

    Article  PubMed  Google Scholar 

  5. Davis SS Jr, Husain FA, Lin E, Nandipati KC, Perez S, Sweeney JF. Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg. 2013;216(1):96–104. https://doi.org/10.1016/j.jamcollsurg.2012.08.014.

    Article  PubMed  Google Scholar 

  6. Igwe E, Hernandez E, Rose S, Uppal S. Resident participation in laparoscopic hysterectomy: impact of trainee involvement on operative times and surgical outcomes. Am J Obstet Gynecol. 2014;211(5):484.e1–7. https://doi.org/10.1016/j.ajog.2014.06.024.

    Article  Google Scholar 

  7. Committee on the Governance and Financing of Graduate Medical Education; Board on Health Care Services; Institute of Medicine; Eden J, Berwick D, Wilensky G (eds) Graduate medical education that meets the nation's health needs. Washington, DC: National Academies Press. 2014. https://doi.org/10.17226/18754

  8. Gonzalez CM, McKenna P. Challenges facing academic urology training programs: an impending crisis. Urology. 2013;81(3):475–9. https://doi.org/10.1016/j.urology.2012.12.004.

    Article  PubMed  Google Scholar 

  9. Hwang CS, Wichterman KA, Alfrey EJ. The cost of resident education. J Surg Res. 2010;163(1):18–23. https://doi.org/10.1016/j.jss.2010.03.013.

    Article  PubMed  Google Scholar 

  10. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8. https://doi.org/10.1097/aog.0000000000000057.

    Article  Google Scholar 

  11. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. https://doi.org/10.1001/jama.300.11.1311.

    Article  CAS  Google Scholar 

  12. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396–403. https://doi.org/10.1097/01.aog.0000263469.68106.90.

    Article  PubMed  Google Scholar 

  13. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. https://doi.org/10.1097/aog.0000000000000286.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. The Cochrane database of systematic reviews (4):Cd004014. https://doi.org/10.1002/14651858.CD004014.pub5.

  15. Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13. https://doi.org/10.1097/AOG.0b013e318231537c.

    Article  PubMed  Google Scholar 

  16. American College of Surgeons. About ACS NSQIP. Available at https://www.facs.org/quality-programs/acs-nsqip/about. Accessed 28 April 2016.

  17. PUF Data Dictionary Items | National Cancer Data Base—Data Dictionary PUF 2013. Available at http://ncdbpuf.facs.org/node/259. Accessed 25 April 2016.

  18. American College of Surgeons National Surgical Quality Improvement Program: user guide for the 2012 ACS NSQIP participant use data file. October 2013. Available at https://www.facs.org/~/media/files/qualityprograms/nsqip/ug12.ashx. Accessed 28 April 2016.

  19. Papandria D, Rhee D, Ortega G, Zhang Y, Gorgy A, Makary MA, et al. Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. J Surg Educ. 2012;69(2):149–55. https://doi.org/10.1016/j.jsurg.2011.08.003.

    Article  Google Scholar 

  20. Gorgun E, Benlice C, Corrao E, Hammel J, Isik O, Hull T, et al. Outcomes associated with resident involvement in laparoscopic colorectal surgery suggest a need for earlier and more intensive resident training. Surgery. 2014;156(4):825–32. https://doi.org/10.1016/j.surg.2014.06.072.

    Article  Google Scholar 

  21. Harrington DT, Roye GD, Ryder BA, Miner TJ, Richardson P, Cioffi WG. A time-cost analysis of teaching a laparoscopic entero-enterostomy. J Surg Educ. 2007;64(6):342–5. https://doi.org/10.1016/j.jsurg.2007.06.009.

    Article  PubMed  Google Scholar 

  22. Saliba AN, Taher AT, Tamim H, Harb AR, Mailhac A, Radwan A, et al. Impact of resident involvement in surgery (IRIS-NSQIP): looking at the bigger picture based on the American College of Surgeons-NSQIP database. J Am Coll Surg. 2016;222(1):30–40. https://doi.org/10.1016/j.jamcollsurg.2015.10.011.

    Article  Google Scholar 

  23. D'Souza N, Hashimoto DA, Gurusamy K, Aggarwal R. Comparative outcomes of resident vs attending performed surgery: a systematic review and meta-analysis. J Surg Educ. 2016;73(3):391–9. https://doi.org/10.1016/j.jsurg.2016.01.002

    Article  Google Scholar 

  24. Patel HD, Ball MW, Cohen JE, Kates M, Pierorazio PM, Allaf ME. Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology. 2015;85(3):552–9. https://doi.org/10.1016/j.urology.2014.11.034.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Allen RW, Pruitt M, Taaffe KM. Effect of resident involvement on operative time and operating room staffing costs. J Surg Educ. 2016;73(6):979–85. https://doi.org/10.1016/j.jsurg.2016.05.014.

    Article  PubMed  Google Scholar 

  26. Mattar SG, Alseidi AA, Jones DB, Jeyarajah DR, Swanstrom LL, Aye RW, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440–9. https://doi.org/10.1097/SLA.0b013e3182a191ca.

    Article  Google Scholar 

  27. De Win G, Van Bruwaene S, Kulkarni J, Van Calster B, Aggarwal R, Allen C, et al. An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events. Adv Med Educ Pract. 2016;7:357–70. https://doi.org/10.2147/amep.s102000.

    Article  Google Scholar 

  28. Finan MA, Clark ME, Rocconi RP. A novel method for training residents in robotic hysterectomy. J Robot Surg. 2010;4(1):33–9. https://doi.org/10.1007/s11701-010-0179-x.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Urology, MetroHealth Medical Center, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA

    Emily A. Slopnick & Carvell T. Nguyen

  2. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Emily A. Slopnick, Adonis K. Hijaz & Simon P. Kim

  3. Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, 44106, OH, USA

    Emily A. Slopnick, Adonis K. Hijaz & Simon P. Kim

  4. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Adonis K. Hijaz, J. Welles Henderson & Sangeeta T. Mahajan

  5. Cancer Outcomes Public Policy and Effectiveness Research (COPPER), Yale University, New Haven, CT, USA

    Simon P. Kim

Authors
  1. Emily A. Slopnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adonis K. Hijaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Welles Henderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sangeeta T. Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carvell T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simon P. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily A. Slopnick.

Ethics declarations

Conflicts of interest

SP Kim is funded by a career development award from the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO) and the NIH from MD12–003.

AK Hijaz is a member of the Astellas, Inc. Speaker’s Bureau.

ST Mahajan is a member of the Astellas, Inc. Speaker’s Bureau and receives grant funding from Allergan, Inc.

EA Slopnick, JW Henderson, and CT Nguyen do not have any conflicts of interest.

Author participation

EA Slopnick: project development, data management, data analysis, manuscript writing and editing; AK Hijaz: project development, manuscript editing; JW Henderson: manuscript editing; ST Mahajan: project development, manuscript editing; CT Nguyen: data management; SP Kim: data management, data analysis, manuscript writing/editing.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Slopnick, E.A., Hijaz, A.K., Henderson, J.W. et al. Outcomes of minimally invasive abdominal sacrocolpopexy with resident operative involvement. Int Urogynecol J 29, 1537–1542 (2018). https://doi.org/10.1007/s00192-018-3578-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-018-3578-6

Keywords

Search

Navigation