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THE IMPACT OF RESIDENT INVOLVEMENT IN MINIMALLY INVASIVE UROLOGIC ONCOLOGY PROCEDURES
Nedim Ruhotina, M.D.1, Julien Dagenais, M.D.1, Giorgio Gandaglia, M.D.2, Akshay Sood, M.D.1, Firas Abdollah, M.D.3, Steven L. Chang, M.D.1, Kola Olugbade, Jr., M.D., M.P.H.1, Arun Rai, M.D.1, Jesse D. Sammon, D.O.3, Marianne Schmid, M.D.1, Maxine Sun, Ph.D.2, Briony Varda, M.D.1, Kevin C. Zorn, M.D.1, Mani Menon, M.D.3, Adam Kibel, M.D.1, Quoc-Dien Trinh, M.D.1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, 3Vattikuti Urology Institute, Detroit, MI, USA.

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 sought to assess the impact of resident participation on surgical outcomes utilizing a large multi-institutional prospec-tively collected database.
METHODS: Relying on the American College of Surgeons National Surgical Quality Im-provement Program (ACS-NSQIP) Participant User Files (2005-2011), we abstracted the three 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 train-ee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY =/>5: chief) vs. attending-only on operative time, length of stay, 30-day complication, reoperation, and readmission rates.
RESULTS: A total of 5,459 minimally invasive radical prostatectomies, 1,740 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 in-creased odds of overall complication, 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 ne-phrectomies (Odds Ratio [OR] 0.49, p=0.04) and prostatectomies (OR 0.68, p=0.01).
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.


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