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Grand Rounds

Does Resident Participation in OB/GYN Surgeries Impact Outcomes?

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BACKGROUND AND PURPOSE:

  • Results on the impact of residents, combining different specialties, have been conflicting
    • ObGyn has not been examined specifically
  • Bougie et al. (Journal of Obstetrics and Gynaecology Canada, 2018) sought to assess the influence of resident participation on OB/GYN surgery

METHODS:

  • Systematic Review and meta-analysis
    • Studies involving OB/GYN
    • RCTs, cohort studies or case-control studies
    • Minimum 10 patients
  • Pre-specified subgroup analysis stratified by type of surgery (cesarean study, hysterectomy, or prolapse repair)
  • Studies compared outcomes for OB/GYN surgery performed by attending surgeons alone or with residents
    • Operative time
    • Estimated blood loss
    • Perioperative complications

RESULTS:

  • 13 studies were included, totaling 40,968 patients
  • Surgical procedures performed only by attending surgeons had shorter operative times
    • Mean difference 18.20 minutes; 95% CI, 13.58-22.82
  • Surgical procedures with resident involvement were associated with an increased risk of blood transfusion
    • risk ratio 1.23; 95% CI, 1.08-1.41
    • When stratified by procedure, this result only found in hysterectomy procedures
  • No observable differences in risk for
    • Estimated blood loss
    • Wound infection
    • Urologic injury
    • Viscus injury
    • Return to the operating room

CONCLUSION:

  • The participation of a resident in OB/GYN surgery is correlated with longer operative times and increased risk of blood transfusion
    • If risk of blood transfusion is 2%, transfusion risk may be increased to 2.5% based on relative risk
  • However, resident participation did not increase perioperative complications
  • Authors stress that this study assesses association and not causation
    • Teaching institutions have other trainees in other disciplines that may directly interact with patient care that will also lengthen the time in the OR

Learn More – Primary Sources:

Influence of Resident Involvement in Obstetrics and Gynaecology Surgery on Surgical Outcomes: Systematic Review and Meta-Analysis

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Related ObG Topics:

Traditional vs. Simulation Training for Laparoscopic Salpingectomy
Vacuum Delivery – What is the Better Training Approach?

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