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Roberto Hernandez-Irizarry, BS Benjamin Zendejas , MD, MSc Shahzad M. Ali, MD

NSQIP Data on Laparoscopic Inguinal Hernia Repairs: Are Residents Too Slow?. Roberto Hernandez-Irizarry, BS Benjamin Zendejas , MD, MSc Shahzad M. Ali, MD Christine Lohse , MS David R. Farley, MD. Outcomes?. Multiple Centers. Community. Academic. Data.

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Roberto Hernandez-Irizarry, BS Benjamin Zendejas , MD, MSc Shahzad M. Ali, MD

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  1. NSQIP Data on Laparoscopic Inguinal Hernia Repairs: Are Residents Too Slow? Roberto Hernandez-Irizarry, BS Benjamin Zendejas, MD, MSc Shahzad M. Ali, MD Christine Lohse, MS David R. Farley, MD

  2. Outcomes? Multiple Centers Community Academic

  3. Data National. Validated. Risk-adjusted Outcomes-based 30 day mortality/morbidity

  4. Data: 2007-2009 • 10,391 patients had Lap IHR • 4,168 had: CABG, Vasectomy… • 6,223 Lap IHR only

  5. Results 8% 92% Mean Age 53 yrs (16-90) OR Time 63 mins (6-303)

  6. Results % Emergent <1 Bilateral 21 Recurrent 13 Resident 57

  7. As PGY operative time 75 70 65 60 Staff + Resident 72 mins 55 Staff 51 mins 50 45 Staff Alone PGY-1 PGY-2 PGY-3 PGY-4 PGY>5 Operative Time P < 0.001 Minutes = 21 mins P < 0.001

  8. Duration of Stay Mean Median Staff 0.2 0 Staff + Resident 0.2 0 Odds Ratio >1d >2d 1.53 1.64 P<0.001

  9. OR >1d PGY Duration of Stay P<0.05

  10. Complications Groin pain, Recurrence, Urinary Retention? Infections Return to OR Nerve Injury Pneumonia Unplanned intubation UTI Dehiscence DVT/PE Renal Failure Sepsis Death

  11. Complications Staff 1.4% Staff + Res 1.7% PGY vs PGY: all p > 0.4 p = 0.3

  12. Mayo vs World Mayo Academic Community 33% 10% 5% Inpatient 0.9% 1.3% 0.9% Comp.

  13. Conclusions Solo staff surgeons are faster Shorter time with juniors vs senior

  14. Conclusions Res + Staff: odds of longer hospital stay Sr. vs Jr. : odds of longer hospital stay

  15. Conclusions NO Difference: - in M&M when residents “participate” - in M&M by resident PGY level

  16. Weaknesses NSQIP: Academic over represented Complications Resident participation? TEP vs TAPP?

  17. Final Thought OR Time 56 mins (6-303) 6 mins 303 mins 1h 2h 3h 4h 5h

  18. NSQIP Data on Laparoscopic Inguinal Hernia Repairs: Are Residents Too Slow? Roberto Hernandez-Irizarry, BS Benjamin Zendejas, MD, MSc Shahzad M. Ali, MD Christine Lohse, MS David R. Farley, MD

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