The Effect of Resident Involvement on Surgical Outcomes for Common Urologic Procedures: A Case Study of Uni- and Bilateral Hydrocele Repair.
OBJECTIVE
Previous studies have investigated the effect of resident involvement (RI) on surgical complications in minimally invasive and complex surgical cases. This study evaluates the effect of surgical education on outcomes in a simple general urologic procedure, unilateral and bilateral hydrocele repair, in a large prospectively collected multi-institutional database.


METHODS
Relying on the American College of Surgeons National Surgical Quality Improvement Program Participant User files (2005-2013), we extracted patients who underwent unilateral or bilateral hydrocele repair using Current Procedural Terminology codes 55040, 55041, and 55060. Cases with missing information on RI were excluded. Descriptive and logistic regression analyses were performed to assess the impact of RI on perioperative outcomes. A prolonged operative time (pOT) was defined as operative time >75th percentile.


RESULTS
Overall, 1378 cases were available for final analyses. The overall complication, readmission, and reoperation rates were 2.3% (32/1378), 0.5% (7/1378), and 1.4% (19/1378), respectively. A pOT was more frequently observed in bilateral procedures (35.2% vs 21.3%, P < .0001) and with RI (33.8% vs 19.0%, P < .0001). Procedures with RI had a 2.2-fold higher odds of pOT (95% confidence interval 1.7-2.8, P < .0001). Overall complications (odds ratio 1.1, 95% confidence interval 0.5-2.3) were not associated with RI (P = .789). In sensitivity analyses, all postgraduate years of training were associated with a pOT (P < .0001).


CONCLUSIONS
Although the involvement of a resident in hydrocele repairs leads to higher odds of pOT, it does not affect patient safety, as evidenced by similar complication rates.
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany. Electronic address: loeppenberg@googlemail.com.
Björn
B
Löppenberg
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Philip J
PJ
Cheng
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Jacqueline M
JM
Speed
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Alexander P
AP
Cole
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Malte W
MW
Vetterlein
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Adam S
AS
Kibel
Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
Joachim
J
Noldus
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Quoc-Dien
QD
Trinh
Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christian P
CP
Meyer
D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000601:surgery*; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000193:education*; D014572:Urology / Q000193:education*