Comparison of Outcomes After Minimally Invasive Versus Open Partial Nephrectomy with Respect to Trainee Involvement Utilizing the American College of Surgeons National Surgical Quality Improvement Program

Kern, Sean; Lustik, Michael B.; McMann, Leah P.; Thibault, Gregory P.; Sterbis, Joseph R.

doi:10.1089/end.2013.0051

Cited by 43 publications

(28 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A large study utilizing the National Surgical Quality Improvement Program (NSQIP) Database found that resident and fellow involvement in renal surgery was associated with higher superficial and overall surgical site infection (SSI) (p<0.05). In addition, PGY 6 resident and fellow involvement was associated with higher organ space infections and overall SSI (p<0.05) [17]. Several other studies in our field, however, have failed to demonstrate an increased risk of complications relative to learner participation [1118].…”

Section: Discussionmentioning

confidence: 99%

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training

2018

View full text Add to dashboard Cite

PurposePrimary 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 MethodsReview 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.ResultsThree 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%.ConclusionsIn 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training

2018

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13][14][15] In an increasingly cost-conscious medical culture, delivering high quality care is of utmost importance, translating in greater involvement of attending surgeons and less resident independence. 12 Moreover, surgical resident education is increasingly challenging due to expense, 19 work hour limitations 20 and an ever-increasing array of minimally-invasive surgical options to complement open surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

“…This has been evaluated in the past in the general surgery literature with mixed results, while data on safety of resident participation in minimallyinvasive urologic surgery is limited. [10][11][12][13][14][15] We examine the impact of resident involvement on critical perioperative outcomes, including operative time, complications, readmission and reoperation rates, as well as length-of-stay. We assessed these endpoints for the commonly performed minimally-invasive urologic oncology procedures using data from American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) participating hospitals.…”

Section: Introductionmentioning

confidence: 99%

The impact of resident involvement in minimally-invasive urologic oncology procedures

Ruhotina¹,

Dagenais²,

Gandaglia³

et al. 2014

CUAJ

View full text Add to dashboard Cite

Introduction: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. Methods: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005Files ( -2011, we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. Results: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic). Conclusions:Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.

show abstract

“…Multiple evaluations of the NSQIP by general surgeons have found an increase in 30‐day complication rates associated with resident involvement in a broad array of general surgery procedures . Increased morbidity associated with resident operative involvement has been seen in orthopedics, plastic surgery, and urology . It has been proposed that increased postoperative morbidity may result from the prolonged operative time associated with resident involvement by way of surgical site infections and venous thromboembolic events from stasis, not necessarily from operative error .…”

Section: Discussionmentioning

confidence: 99%

The impact of surgical trainee participation on sinus surgery outcomes

et al. 2015

View full text Add to dashboard Cite

show abstract

Comparison of Outcomes After Minimally Invasive Versus Open Partial Nephrectomy with Respect to Trainee Involvement Utilizing the American College of Surgeons National Surgical Quality Improvement Program

Cited by 43 publications

References 26 publications

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training

The impact of resident involvement in minimally-invasive urologic oncology procedures

The impact of surgical trainee participation on sinus surgery outcomes

Contact Info

Product

Resources

About