title: The Effect of Resident Involvement on Perioperative Outcomes in Transurethral Urologic Surgeries.
abstract: OBJECTIVE
  To conduct the first study of intra- and postoperative outcomes related to intraoperative resident involvement in transurethral resection procedures for benign prostatic hyperplasia and bladder cancer in a large, multi-institutional database.
  
  
  METHODS
  Relying on the American College of Surgeons National Surgical Quality Improvement Program Participant User Files (2005-2012), we abstracted all cases of endoscopic prostate surgery (EPS) for benign prostatic hyperplasia and transurethral resection of bladder tumors (TURBTs). Multivariable logistic regression models were constructed to assess the effect of trainee involvement (postgraduate year [PGY] 1-2: junior, PGY 3-4: senior, PGY ≥ 5: chief or fellow) vs attending only on operative time and length of hospital stay, as well as 30-day complication, reoperation, and readmission rates.
  
  
  RESULTS
  In all, 5093 EPS and 3059 TURBTs for a total of 8152 transurethral resection procedures were performed during the study period for which data on resident involvement were available. In multivariable analyses, resident involvement in EPS or TURBT was associated with increased odds of prolonged operative times and hospital readmissions in 30 days independent of resident level of training. Resident involvement was not associated with overall complications or reoperation rates.
  
  
  CONCLUSIONS
  Resident involvement in lower urinary tract surgeries is associated with increased readmissions. Strategies to optimize resident teaching of these common urologic procedures in order to minimize possible risks to patients should be explored.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Urology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: callard@mgh.harvard.edu.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Allard
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts; Division of Urology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gelpi-Hammerschmidt
authors.affiliation: Center for Surgery and Public Health and Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Preston
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011470:Prostatic Hyperplasia / Q000601:surgery*; D016896:Treatment Outcome; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000193:education*
keywords: Patient Care; Practice-Based Learning and Improvement; benign prostatic hyperplasia; bladder cancer; complications; surgical education