The Impact of Resident Involvement on Surgery for Pelvic Organ Prolapse

Introduction Prior research shows that when urogynecologists perform surgery with fellows, operative time increases, without increased adverse events/prolapse recurrence. Outside fellowship training programs, urogynecologists operate with obstetrician/gynecologist (OB/GYN) residents (RES) or physician assistants (PAs). We compared operative time and complications when urogynecologists operate with RES versus PA. We hypothesized that attendings operating with RES would increase operative times without increasing adverse events.  Methods This retrospective cohort study included all apical pelvic organ prolapse (POP) repairs performed between June 2016 and July 2020 by a single fellowship-trained urogynecologist at two community hospitals, with comparisons between RES and PAs. Results We identified 108 POP repairs, with 77 (71.3%) performed with RES assistants and 31 (28.7%) with PAs. RES cases had longer operative times than PA cases (187.5 ± 80.3 vs. 155.7 ± 53.2 minutes, p = 0.045). After adjusting for surgical route, BMI, concomitant hysterectomy, and midurethral sling placement, RES cases remained 49.0 minutes longer (p < 0.001). Complication rates were similar on univariable analysis (24.7% vs. 9.7%, p = 0.11). Urinary tract infections (UTIs) accounted for most complications (12/22, 54%) and did not differ by assistant type (13.0% RES vs. 6.5% PA, p = 0.503). When UTIs were excluded, there were no differences in composite complications (14.5% vs. 3.2%, p = 0.173), though the low number of events limited regression analysis. RES cases also had greater estimated blood loss (64.4 ± 66.4 vs. 33.2 ± 20.6 mL, p < 0.001). Conclusions When an expert surgeon operated with a resident rather than a PA, operative time was 49 minutes longer (approximately 30% longer overall). However, complication rates did not increase.