title: The impact of resident involvement in male one-stage anterior urethroplasties.
abstract: OBJECTIVE
  To assess the effect of resident involvement in male anterior urethroplasties with regard to perioperative and postoperative outcomes using a large multi-institutional prospectively collected database.
  
  
  METHODS
  Relying on the American College of Surgeons National Surgical Quality Improvement Program Participant User Files (2005-2012), we extracted all entries with Current Procedural Terminology coding for male one-stage anterior urethroplasty in men (54,310). Cases with missing entries on resident involvement were excluded. Descriptive and logistic regression analyses were constructed to assess the impact of trainee involvement (attending only vs resident) on perioperative and postoperative outcomes. Prolonged operative time (pOT) was defined as operative time >75th percentile (>204 minutes).
  
  
  RESULTS
  A total of 235 one-stage urethroplasties were performed during the study period, for which resident involvement was available. Resident involvement was significantly associated with younger patient age (P = .011) and patients with a pre-existing diabetic condition (P = .047). In univariate analyses, the rate of pOT was significantly higher in the resident involvement group (P = .027). In multivariate models, resident involvement was an independent predictor of pOT (odds ratio, 2.4; 95% confidence interval, 1.3-9.7; P = .035). There were no differences in 30-day postoperative complications, length of hospital stay, or readmissions. Limitations of the study include inability to adjust for case complexity and type of reconstruction.
  
  
  CONCLUSIONS
  Resident involvement is associated with pOT for anterior urethral strictures. However, it does not adversely affect complication rates or the length of hospital stay.
authors: Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: christian.p.meyer@gmail.com.
authors: Christian P
authors: CP
authors: Meyer
authors: Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
authors: Julian
authors: J
authors: Hanske
authors: Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
authors: David F
authors: DF
authors: Friedlander
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Marianne
authors: M
authors: Schmid
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Roland
authors: R
authors: Dahlem
authors: Department of Pathology and Cellular Biology, Université de Montréal, Montreal, Canada.
authors: Vincent Q
authors: VQ
authors: Trinh
authors: Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Steven L
authors: SL
authors: Chang
authors: Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Adam S
authors: AS
authors: Kibel
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Felix K H
authors: FK
authors: Chun
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Margit
authors: M
authors: Fisch
authors: Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Jairam R
authors: JR
authors: Eswara
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission; D059035:Perioperative Period; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D014525:Urethral Stricture / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D014572:Urology / Q000193:education*