Page 1
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?
Page 5
Data
National. Validated. Risk-adjusted
Outcomes-based
30 day mortality/morbidity
Page 6
Data: 2007-2009
• 10,391 patients had Lap IHR
• 4,168 had: CABG, Vasectomy…
• 6,223 Lap IHR only
Page 7
Results
Mean Age 53 yrs (16-90)OR Time 63 mins (6-303)
92% 8%
Page 9
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
Page 11
Duration of Stay
Mean Median
Staff 0.2 0Staff + Resident 0.2
0 >1d >2d
1.53 1.64
Odds Ratio
P<0.001
Page 14
Complications
Infections Return to OR Nerve Injury
Pneumonia Unplanned intubation UTI
Dehiscence DVT/PE Renal Failure
Sepsis Death
Groin pain, Recurrence, Urinary Retention?
Page 17
Conclusions
Solo staff surgeons are faster
Shorter time with juniors vs senior
Page 18
Conclusions
Res + Staff: odds of longer hospital staySr. vs Jr. : odds of longer hospital stay
Page 19
Conclusions
NO Difference: - in M&M when residents
“participate”- in M&M by resident PGY level
Page 20
WeaknessesNSQIP: Academic over represented
Complications
Resident participation?
TEP vs TAPP?
Page 22
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?