title: The impact of resident involvement in minimally-invasive urologic oncology procedures.
abstract: BACKGROUND
  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 (2005-2011), 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.
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Nedim
authors.initials: N
authors.lastname: Ruhotina
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Julien
authors.initials: J
authors.lastname: Dagenais
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC;
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; ; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA;
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA;
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Kola
authors.initials: K
authors.lastname: Olugbade
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Arun
authors.initials: A
authors.lastname: Rai
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; ; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA;
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Briony
authors.initials: B
authors.lastname: Varda
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC;
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA;
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh