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?