Impact of Trainee Involvement on Surgical Outcomes of Abdominal and Laparoscopic Myomectomy

Abstract

<h3>Study Objective</h3> To determine the impact of trainee involvement on operative time and transfusion risk for myomectomy. <h3>Design</h3> Cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database of abdominal and laparoscopic myomectomies with trainee involvement versus (vs) no trainee involvement from 2008 - 2012 (the most recent years that trainee involvement was a variable in the database). <h3>Setting</h3> Trainee involvement in myomectomy. <h3>Patients or Participants</h3> 1216 patients. <h3>Interventions</h3> Preoperative factors, intraoperative outcomes, and 30-day postoperative complications were evaluated. The primary outcomes were operative time and rate of transfusion. Continuous variables were assessed with Wilcoxon rank tests. Categorical variables were assessed with χ2 tests. <h3>Measurements and Main Results</h3> Overall, 64% (n=775/1216) of myomectomies had trainee involvement. Trainee involvement was associated with a 31 minute (min) longer operative time (92 vs 123min, p<0.01). This difference persisted for abdominal myomectomy (89 vs 115min, p<0.01) including both 1-4 myomas/weight ≤250g (79 vs 104min, p<0.01) and ≥5 myomas/weight >250g (104 vs 143min, p<0.01). However, for laparoscopic myomectomy, there was no difference in operative time (152 vs 155min, p=0.45). There was a higher rate of transfusion between no trainee vs trainee (3% vs 9%, p<0.01) for myomectomies overall. However, when stratified, only abdominal myomectomies with ≥5 myomas/weight >250g demonstrated a higher rate of transfusion (3% vs 18%, p<0.01) and there was no difference in rate of transfusion for laparoscopic myomectomy (6% vs 4%, p=0.47). There was no difference in the number of overall complications of myomectomy (3% vs 4%, p=0.34). <h3>Conclusion</h3> Trainee involvement was associated with increased operative time for abdominal myomectomy and rates of transfusion for abdominal myomectomy with a high fibroid burden. Trainee involvement does not affect operative time or rates of transfusion for laparoscopic myomectomy. When appropriate, myomectomies with trainees should be performed via a minimally invasive approach.