Resident Involvement in Radical Inguinal Orchiectomy for Testicular Cancer Does Not Adversely Impact Perioperative Outcomes - A Retrospective Study

Abstract

Introduction: 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. Materials and 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.

Impact of residents’ involvement in urological surgeries: a systematic review

“…Matulewicz et al reported that the residents' population had significantly higher operative times and hospital stays, which is also reported by Kern et al, Aisen et al, Allard et al, Yip et al23,24,26,33,34 Although the presence of residents was significantly associated with increased operative time in the performed surgeries, the length of hospital stay was not significantly different from the nonresident group, in the studies by Meyer et al, and Vetterlein et al, Benjamin et al, and Privé et al reported that longer operative time was associated with the residents' group, however, no complications were significantly noticed.…”

“…Based on the NSQIP data also, Meyer et a, Vetterlein et al and Yip et al investigated similar outcomes in patients that underwent one-stage anterior urethroplasties, orchiectomy, minimally-invasive, and male infertility procedures, respectively. [24][25][26] They reported that the presence of residents was not a significant predictor for the occurrence of adverse events and complications. This was also supported by Privé et al, Allard et al and Del Rosso et al that reported that although residents induced some complications, these were managed intraoperatively.…”

“…In the study by Matulewicz et al, the presence of residents was associated with significantly lower rates of reoperations as compared to the non-residents' population which was also supported by Holland et al, and Allard et al on the other hand, Meyer et al reported that none of the patients were readmitted for reoperation in their study, which was also reported by Löppenberg et al, although attendant students had some rates of reoperation and readmission, but with no significance. 23,24,28,32,35 Moreover, Benjamin et al reported that reoperations were not significantly associated with residents' performance in a 6-month follow-up period. This was also reported by Ku et al, and Yip et al 26,30,31 Impact on the operative time 24,25,27,30 Interestingly, Ku et al reported that patients that underwent surgeries by residents did not significantly stay in hospitals for longer periods although the operative time was significantly prolonged in these patients.…”

“…23,24,28,32,35 Moreover, Benjamin et al reported that reoperations were not significantly associated with residents' performance in a 6-month follow-up period. This was also reported by Ku et al, and Yip et al 26,30,31 Impact on the operative time 24,25,27,30 Interestingly, Ku et al reported that patients that underwent surgeries by residents did not significantly stay in hospitals for longer periods although the operative time was significantly prolonged in these patients. 31 Longer operative time was also reported by Holland et al 32 .…”

Where do urologists stand in the era of novel coronavirus-2019 disease

“…Orchidectomy also serves the purpose of providing tissue for diagnosis and risk stratification to determine further management including chemotherapy [41]. Inguinal orchidectomy for testicular cancer can be performed as a day case procedure, reducing pressure on beds [42]. Therefore, radical orchidectomy is high priority and should be performed whenever possible.…”