Impact of Trainee Involvement on Complication Rates Following Pelvic Reconstructive Surgery

Trainee involvement in surgical procedures has been associated with longer surgical times and increased rates of certain complications. There has been limited study of the impact trainee involvement has on outcomes in urogynecologic surgery. We sought to determine the impact of resident and fellow involvement in pelvic reconstructive surgeries on 30-day complication rates.

Using the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent pelvic floor surgery were identified between 2010 and 2015. Patients were stratified into 3 groups: no trainee, resident, or fellow involvement. The primary outcome was the composite complication rate. Three-group comparison was performed using Kruskal-Wallis analysis. If statistically significant, then pairwise analysis was performed between the reference group (attending alone) and experimental groups (resident or fellow). Additional pairwise analysis was performed between the fellow and resident groups. Logistic regression was used to identify factors associated with an increased risk of complications.

Seven thousand seven hundred fifty-two surgical cases met all criteria for inclusion; 2440 (31.4%) included residents, and 646 (8.3%) included fellows. The median operating times were significantly higher in the resident and fellow groups compared with the attending-alone group (109 minutes [interquartile range, 55-164 minutes) compared with 110 minutes [interquartile range, 61-174 minutes] compared with 72 minutes [interquartile range, 38-113 minutes], P < 0.001). After multivariable logistic regression, trainee participation did not result in an increase in complication rate. Preoperative transfusion (adjusted odds ratio [aOR], 7.82; 95% confidence interval [CI], 2.03-30.09), coagulopathy (aOR, 3.18; 95% CI, 1.74-5.82), nonwhite race (aOR, 1.57; 95% CI, 1.31-1.89), insulin-dependent diabetes (aOR, 1.68; 95% CI, 1.03-2.72), American Society of Anesthesiologists class greater than 2 (aOR, 1.46; 95% CI, 1.21-1.77), length of stay (aOR, 1.04, 95%CI:1.02-1.06), operating time (aOR, 1.01; 95% CI, 1.00-1.03), and undergoing a sling procedure (aOR, 1.18; 95% CI, 1.01-1.41) were associated with higher complication rates.

Resident and fellow involvement during pelvic reconstructive surgery is associated with longer operating times but does not increase the risk of complications within 30 days of the procedure.