Roberto Hernandez-Irizarry, BS Benjamin Zendejas , MD, MSc Shahzad M. Ali, MD
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Transcript of Roberto Hernandez-Irizarry, BS Benjamin Zendejas , MD, MSc Shahzad M. Ali, MD
Roberto Hernandez-Irizarry, BSBenjamin Zendejas, MD, MSc
Shahzad M. Ali, MDChristine Lohse, MSDavid R. Farley, MD
NSQIP Data on Laparoscopic Inguinal Hernia Repairs:
Are Residents Too Slow?
Outcomes?
Multiple Centers
Community Academic
Data
National. Validated. Risk-adjusted
Outcomes-based
30 day mortality/morbidity
Data: 2007-2009
• 10,391 patients had Lap IHR
• 4,168 had: CABG, Vasectomy…
• 6,223 Lap IHR only
Results
Mean Age 53 yrs (16-90)OR Time 63 mins (6-303)
92% 8%
Results%
Emergent <1
Bilateral 21
Recurrent 13
Resident 57
Operative Time
Minutes
StaffAlone
PGY-1 PGY-2 PGY-3 PGY-4 PGY>545
50
55
60
65
70
75
P < 0.001
= 21 mins
As PGY operative timeP <
0.001
51 mins
Staff
Staff + Resident72 mins
Duration of Stay
Mean Median
Staff 0.2 0Staff + Resident 0.2
0 >1d >2d
1.53 1.64
Odds Ratio
P<0.001
Duration of Stay
OR >1d
PGY1 2 3 4 51
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
P<0.05
Complications
Infections Return to OR Nerve Injury
Pneumonia Unplanned intubation UTI
Dehiscence DVT/PE Renal Failure
Sepsis Death
Groin pain, Recurrence, Urinary Retention?
Staff 1.4%
Staff + Res 1.7%
PGY vs PGY: all p > 0.4
p = 0.3
Complications
Mayo vs World
Mayo Academic Community
Comp.
Inpatient
0.9% 1.3% 0.9%
33% 10% 5%
Conclusions
Solo staff surgeons are faster
Shorter time with juniors vs senior
Conclusions
Res + Staff: odds of longer hospital staySr. vs Jr. : odds of longer hospital stay
Conclusions
NO Difference: - in M&M when residents
“participate”- in M&M by resident PGY level
WeaknessesNSQIP: Academic over represented
Complications
Resident participation?
TEP vs TAPP?
Final Thought
OR Time 56 mins (6-303)
6 mins 303 mins
1h 2h 3h 4h 5h
Roberto Hernandez-Irizarry, BSBenjamin Zendejas, MD, MSc
Shahzad M. Ali, MDChristine Lohse, MSDavid R. Farley, MD
NSQIP Data on Laparoscopic Inguinal Hernia Repairs:
Are Residents Too Slow?