Impact of resident involvement on urological surgery outcomes: an analysis of 40,000 patients from the ACS NSQIP database.
OBJECTIVE
In addition to excellent patient care, the focus of academic medicine has traditionally been resident training. The changing landscape of health care has placed increased focus on objective outcomes. As a result, the surgical training process has come under scrutiny for its influence on patient care. We elucidated the effect of resident involvement on patient outcomes.


METHODS
We retrospectively analyzed data from the 2005 to 2011 NSQIP® participant use database. Patients were separated into 2 cohorts by resident participation vs no participation. The cohorts were compared based on preoperative comorbidities, demographic characteristics and intraoperative factors. Confounders were adjusted for by propensity score modification and complications were analyzed using perioperative variables as predictors.


RESULTS
A total of 40,001 patients met study inclusion criteria. Raw data analysis revealed that cases with resident participation had a higher rate of overall complications. However, after propensity score modification there was no significant difference in overall, medical or surgical complications in cases with resident participation. Resident participation was associated with decreased odds of overall complications (0.85). Operative time was significantly longer in cases with resident participation (159 vs 98 minutes).


CONCLUSIONS
Urology resident involvement is not associated with increased overall and surgical complications. It may even be protective when adjusted for appropriate factors such as case mix, complexity and operative time.
Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Richard S
RS
Matulewicz
Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Matthew
M
Pilecki
Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Aksharananda
A
Rambachan
Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
John Y S
JY
Kim
Departments of Urology and Surgery (MP, AR, JYSK), Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: skundu@nmff.org.
Shilajit D
SD
Kundu
D002983:Clinical Competence; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D016896:Treatment Outcome; D014572:Urology / Q000193:education* / Q000592:standards*
complications; internship and residency; outcome assessment (health care); quality of health care; urology