Impact of Minimally Invasive Gynecology Fellowship Training on Patient Outcomes at Hysterectomy
CANSAGE ePoster Library. Shirreff L. 09/27/19; 275247; eP-114
Lindsay Shirreff
Lindsay Shirreff
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Abstract
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Objective: Evaluate differences in outcomes for hysterectomies performed by Fellowship-trained surgeons compared to Generalists. Methods: Retrospective review of hysterectomies at 5 Toronto hospitals from July 2016 to June 2018. Patient outcomes for Fellowship-trained surgeons (minimum 6 months fellowship training) were compared to those without post-residency training (Generalist). Hysterectomies performed by urogynecologists were excluded. Primary outcome was complications (in-hospital to 30-days of discharge). Secondary outcomes were grade of complication and return to emergency room (ER). Binary logistic regression analysis was performed comparing Fellowship versus Generalist cases controlling for factors associated with case complexity. Results: 1379 hysterectomies were included (702 cases by 17 Fellowship surgeons and 677 cases by 41 Generalists). Fellowship cases were more likely to have endometriosis (19.9% vs. 7.9%, p<0.001), adhesions (46.1% vs. 31.2%, p<0.001) and additional procedures (resection of endometriosis (22.9% vs. 4.4%, p<0.001); ureterolysis (27.2% vs. 3.2%, p<0.001) and lysis of adhesions (28.1% vs. 8.9%, p<0.001)). Fellowship surgeons had higher overall technicity (84.9% vs. 66.7%, p<0.001) but lower vaginal hysterectomy rate (5.0% vs. 16.9%, p<0.001). After controlling for patient and surgical factors, there was no difference in all complications (OR 1.30, 95% CI 0.89–1.90, p=0.18) or grade 2 complications (OR 1.18, 95% CI 0.75–1.86, p=0.47). Fellowship surgeons had fewer patients returning to ER (OR 0.45, 95% CI 0.25–0.81, p=0.01). Conclusion: There was no difference in complications for hysterectomies among Fellowship and Generalist surgeons. Fellowship surgeons had greater technicity rate. Cases performed by Fellowship surgeons were more complex with higher chance of additional procedures.
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