title: Resident Involvement in Radical Inguinal Orchiectomy for Testicular Cancer Does Not Adversely Impact Perioperative Outcomes - A Retrospective Study.
abstract: BACKGROUND
  To evaluate perioperative outcomes related to resident involvement (RI) in a large and prospectively collected multi-institutional database of patients undergoing orchiectomy for testicular cancer.
  
  
  METHODS
  Using current procedural terminology and ICD-9 codes, information about patients with testicular cancer were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database (2006-2013). Multivariable analyses evaluated the impact of RI on outcomes after orchiectomy. Prolonged operative time (pOT) and prolonged length of stay were defined by the 75th percentile (59 min) and postoperative inpatient stay ≥2 days, respectively.
  
  
  RESULTS
  Overall, 267 patients underwent orchiectomy either with (38.6%) or without (61.4%) RI. In all, 89.1% of patients underwent an outpatient procedure. The median body mass index was 26.8 and baseline characteristics between the 2 groups were similar. Overall complications, re-intervention, and bleeding-related complication rates were 2.6, 0.7, and 0.4%, respectively. Although there was no difference in terms of overall complications between the groups (3.9 vs. 1.8%; p = 0.44), RI resulted in pOT (32 vs. 19.5%; p = 0.028). In multivariable analyses, RI predicted pOT (OR 1.89, 95% CI 1.06-3.37; p = 0.031), without association with prolonged length of stay and overall complications.
  
  
  CONCLUSIONS
  RI during orchiectomy for testicular cancer does not undermine patient safety at the cost of pOT.
authors: Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass., USA.
authors: Malte W
authors: MW
authors: Vetterlein
authors: Thomas
authors: T
authors: Seisen
authors: Björn
authors: B
authors: Löppenberg
authors: Nawar
authors: N
authors: Hanna
authors: Philip J
authors: PJ
authors: Cheng
authors: Margit
authors: M
authors: Fisch
authors: Felix K-H
authors: FK
authors: Chun
authors: Adam S
authors: AS
authors: Kibel
authors: Mark A
authors: MA
authors: Preston
authors: Christian P
authors: CP
authors: Meyer
mesh_terms: D000328:Adult; D016208:Databases, Factual; D006470:Hemorrhage; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000601:surgery*; D061646:Operative Time; D009919:Orchiectomy; D059035:Perioperative Period; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D058996:Quality Improvement; D012189:Retrospective Studies; D012306:Risk; D013736:Testicular Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complication; Orchiectomy; Patient safety; Residency; Testicular neoplasm