Purpose: To evaluate the impact of obstetrician and gynecology (OB/GYN) residents on operative costs and surgical outcomes of laparoscopic sterilizations.
Background: Previous research on major gynecologic surgeries has shown that resident involvement is associated with longer operative times and increased risk of blood transfusions. Further research is needed to assess the impact of OB/GYN residents on surgical outcomes of minor laparoscopic procedures like sterilizations.
Methods: We performed a retrospective chart review of patients who underwent laparoscopic sterilization between January 1, 2013 and December 31, 2019 at a community teaching hospital. Outcome data included operative time, operating room cost, supply cost, recovery time, and post-operative pain scores. Cost data was adjusted for medical inflation. Surgeon and anesthesia professional costs were not included.
Results: In multivariate analysis, resident involvement added $141 to total operative cost (p< .0001) and 3.4 minutes to total operative time (p< .0001). For comparison, bilateral salpingectomy added $665 and 16.4 minutes per case. Each additional unit of patient BMI added $17 and 0.4 minutes per case, and each additional year of patient age added $9 and 0.2 minutes per case. The experience of the primary surgeon (in years) was not significant. There was no significant difference in supply cost, patient recovery minutes, or maximum post-operative pain score with resident involvement.
Discussions: OB/GYN resident involvement in interval laparoscopic sterilization procedures was associated with a $141 (5.6%) increase in operative cost and a 3.4 minute (6.0%) increase in operative time. Resident involvement did not impact post-operative outcomes including recovery time and post-operative pain.
Topics: CREOG & APGO Annual Meeting, 2021, Student, Resident, Faculty, Patient Care, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Team-Based Learning, Minimally Invasive Surgery,
Alexandra Smick, MD, TriHealth; Michael Holbert, MD; James Sosnowski, MD; Ronald Merkel, MD
