Extirpative renal surgery volume in training: different roads to the (same?) destination

Area of Science:

• Surgical training and education
• Urology
• Pediatric surgery

Background:

• Extirpative renal surgery (ERS) is a critical procedure in pediatric urology and surgery.
• Understanding training volumes is essential for evaluating surgical competency and patient outcomes.
• Previous studies suggest similar short-term outcomes for ERS in malignancy between pediatric urology (PU) and pediatric surgery (PS) specialists.

Purpose of the Study:

• To quantify and compare the overall training volume of extirpative renal surgery (ERS) for pediatric urology fellows (PU_fel) and pediatric surgery fellows (PS_fel).
• To analyze the distribution of ERS case volume between residency and fellowship training for both PU and PS.

Main Methods:

• Analysis of Accreditation Council for Graduate Medical Education (ACGME) case log data from 2013-2016.
• Inclusion of case logs for surgery residents (S_res), urology residents (U_res), PS_fel, and PU_fel.
• Estimation of total training volume using mean case numbers and comparison between groups via student's t-test.

Main Results:

• A total of 4447 residents and fellows were included in the analysis.
• Pediatric urology fellows (PU_fel) reported a significantly higher mean ERS volume (113.1) compared to pediatric surgery fellows (PS_fel) (10.3) (p < 0.001).
• For PU, ERS volume was greater during residency than fellowship, whereas for PS, the opposite trend was observed. PU_fel performed more ERS than PS_fel (11.7 vs. 7.0, p < 0.001).

Conclusions:

• Significant disparities exist in extirpative renal surgery (ERS) training volumes between pediatric urology (PU) and pediatric surgery (PS) specialists.
• Pediatric urology training yields a higher overall ERS experience, primarily gained during residency.
• Further research is warranted to investigate the impact of these differential training volumes on long-term patient outcomes.