#Grand Rounds

Does Resident Participation in OB/GYN Surgeries Impact Outcomes?

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

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

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

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

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