Effect of Surgical Trainee Presence on Vaginal Hysterectomy Outcomes

Abstract

Study ObjectiveBecause of the rapid decline in vaginal hysterectomy (VH) cases in recent years, there is concern regarding gynecologic surgical training and proficiency for VH. The objective of this study is to determine the effect of surgical trainee involvement on surgical outcomes in VH cases performed for benign indications. DesignRetrospective, multicenter, cohort study (Canadian Task Force classification II-2). SettingParticipating hospitals in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) at various international sites. PatientsWomen who underwent VH for benign indication enrolled from the ACS-NSQIP from 2006 to 2012. InterventionACS-NSQIP database. Measurements and Main ResultsOur study included 5756 patients who underwent VH, and surgical trainees were present in 2276 cases (39.5%). Patients who had a trainee present during VH were more likely to be older, nonsmoking, have comorbidities, and be classified as American Society of Anesthesiologists class III or IV. They were also more likely to be admitted as inpatients, undergo concomitant adnexal surgery, and have uterine weight greater than 250 g. Trainee presence during VH was associated with increased rates of overall complications (5.1% vs 3.19%, p < .001), urinary tract infection (5.27% vs 2.64%, p < .001), and operative time (124.25 ± 59.29 minutes vs 88.64 ± 50.9 minutes, p < .001). After controlling for baseline characteristics, trainee presence was associated with increased odds of overall complications (adjusted odds ratio, 1.63; 95% confidence interval, 1.25–2.13), urinary tract infection (adjusted odds ratio, 2.02; 95% confidence interval, 1.51–2.69), and prolonged operative time (adjusted odds ratio, 3.65; 95% confidence interval, 3.20–4.15). No differences were observed for other measures of surgical morbidity or mortality. ConclusionDespite the increased patient complexity and operative time associated with teaching cases, the involvement of surgical trainees is associated with urinary tract infection but not with any major surgical morbidity or mortality. These findings have important implications for gynecologic surgical training for VH.