733 OUTCOMES AFTER MINIMALLY-INVASIVE VS OPEN PARTIAL NEPHRECTOMY WITH TRAINEE INVOLVEMENT USING THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (II)1 Apr 2013733 OUTCOMES AFTER MINIMALLY-INVASIVE VS OPEN PARTIAL NEPHRECTOMY WITH TRAINEE INVOLVEMENT USING THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM Sean Kern, Michael Lustik, Leah McMann, Gregory Thibault, and Joseph Sterbis Sean KernSean Kern Tripler Army Medical Center, HI More articles by this author , Michael LustikMichael Lustik Honolulu, HI More articles by this author , Leah McMannLeah McMann Tripler Army Medical Center, HI More articles by this author , Gregory ThibaultGregory Thibault Tripler Army Medical Center, HI More articles by this author , and Joseph SterbisJoseph Sterbis Tripler Army Medical Center, HI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.296AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Introduction: We sought to identify complication rates of open partial nephrectomies (OPN) and minimally invasive partial nephrectomies (MIPN) and how they are influenced by trainee involvement utilizing an independent national surgical database. METHODS Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a risk-adjusted data collection analyzing risk factors, demographics, and 30-day perioperative outcomes. From 2005-2010, we identified 1,251 partial nephrectomies, of which 525 were MIPN and 726 were OPN. RESULTS Results: Analysis showed a decreased risk of overall morbidity, serious morbidity, and surgical site infections (SSI); specifically superficial SSI, urinary tract infection, and bleeding (p<0.005) in MIPN than OPN (Table I). Resident and fellow versus attending only involvement was associated with increased rates of overall, serious, and non-serious morbidity, superficial and overall SSI, bleeding, and sepsis or septic shock (p<0.05) (Table II). Post-graduate year (PGY) 1-5 residents had a significantly lower likelihood of non-serious morbidity, organ space and overall SSI, and sepsis or septic shock compared to PGY 6 residents and fellows (Figure I). Length of stay and operative times were significantly shorter with MIPN than OPN (3.2 vs. 5.1 days; p<0.0001) and (185.7 vs. 209.7 minutes, p<0.001). CONCLUSIONS Conclusions: This is the first report utilizing ACS NSQIP to review surgical approaches as well as the impact of trainee involvement on clinical outcomes. The increased complication rates and cost of healthcare might be mitigated by awareness, investment in surgical simulation labs, and competency assessment. Table I. Comparison of 30-day for partial nephrectomies at ACS NSQIP hospitals (2005-2010) 30 Day Outcomes Open Minimally Invasive Total P value (n=726; 58.0%) (n=525; 42.0%) (n=1,251) Overall morbidity 109 (15.0) 45 (8.6) 154 (12.3) < 0.001 ⁎ Serious morbidity 90 (12.4) 33 (6.3) 123 (9.8) < 0.001 ⁎ Non-serious morbidity 46 (6.3) 21 (4.0) 67 (5.4) 0.075 SSI 23 (3.2) 4 (0.8) 27 (2.2) 0.005 ⁎ Mortality 3 (0.4) 2 (0.4) 5 (0.4) 1.000 Individual morbidities Superficial SSI 10 (1.4) 1 (0.2) 11 (0.9) 0.030 ⁎ Deep incisional SSI 5 (0.7) 1 (0.2) 6 (0.5) 0.410 Organ space SSI 12 (1.7) 2 (0.4) 14 (1.1) 0.053 Wound disruption 3 (0.4) 3 (0.6) 6 (0.5) 0.700 Pneumonia 6 (0.8) 5 (1.0) 11 (0.9) 1.000 Unplanned intubation 8 (1.1) 2 (0.4) 10 (0.8) 0.207 Pulmonary embolism 6 (0.8) 5 (1.0) 11 (0.9) 1.000 Failure to wean (on ventilator >48hrs) 8 (1.1) 3 (0.6) 11 (0.9) 0.375 Renal failure 13 (1.8) 3 (0.6) 16 (1.3) 0.074 Urinary tract infection 23 (3.2) 7 (1.3) 30 (2.4) 0.040 ⁎ Neurologic event 4 (0.6) 0 (0.0) 4 (0.3) 0.144 Cardiac arrest requiring CPR 5 (0.7) 2 (0.4) 7 (0.6) 0.706 Myocardial infarction 5 (0.7) 2 (0.4) 7 (0.6) 0.706 Bleeding 41 (5.6) 12 (2.3) 53 (4.2) 0.004 ⁎ DVT 3 (0.4) 7 (1.3) 10 (0.8) 0.105 Sepsis or septic shock 21 (2.9) 7 (1.3) 28 (2.2) 0.081 ⁎ Statistically Significant © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e301-e302 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Kern Tripler Army Medical Center, HI More articles by this author Michael Lustik Honolulu, HI More articles by this author Leah McMann Tripler Army Medical Center, HI More articles by this author Gregory Thibault Tripler Army Medical Center, HI More articles by this author Joseph Sterbis Tripler Army Medical Center, HI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...