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Master of Public Health

Impact of trainees involvement on surgical outcomes of abdominal and laparoscopic myomectomy

AUTHORS

Fajardo OM , Grebenyuk E , Chaves KF , Zhao Z , Ding T , Curlin HL , Harvey LFB , . Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2024 3 23; 44(1). 2330697

ABSTRACT

BACKGROUND: To determine the association of trainees involvement with surgical outcomes of abdominal and laparoscopic myomectomy including operative time, rate of transfusion, and complications.

METHODS: A retrospective cohort study of 1145 patients who underwent an abdominal or laparoscopic myomectomy from 2008-2012 using the American College of Surgeons National Surgical Quality Improvement Program database (Canadian Task Force Classification II-2).

RESULTS: Overall, 64% of myomectomies involved trainees. Trainees involvement was associated with a longer operative time for abdominal myomectomies (mean difference 20.17 minutes, 95% Confidence Interval (CI) [11.37,28.97],  < 0.01) overall and when stratified by fibroid burden. For laparoscopic myomectomy, there was no difference in operative time between trainees vs no trainees involvement (mean difference 4.64 minutes, 95% CI [-18.07,27.35],  = 0.67). There was a higher rate of transfusion with trainees involvement for abdominal myomectomies (10% vs 2%,  < 0.01; Odds Ratio (OR) 5.62, 95% CI [2.53,12.51],  < 0.01). Trainees involvement was not found to be associated with rate of transfusion for laparoscopic myomectomy (4% vs 5%,  = 0.86; OR 0.82, 95% CI [0.16,4.14],  = 0.81). For abdominal myomectomy, there was a higher rate of overall complications (15% vs 5%,  < 0.01; OR 2.96, 95% CI [1.77,4.93],  < 0.01) and minor complications (14% vs 4%,  < 0.01; OR 3.71, 95% CI [2.09,6.57],  < 0.01) with no difference in major complications (3% vs 2%, p = 0.23). For laparoscopic myomectomy, there was no difference in overall (6% vs 10%  = 0.41; OR 0.59, 95% CI [0.18,2.01],  = 0.40), major (2% vs 0%,  = 0.38), or minor (5% vs 10%,  = 0.32; OR 0.52, 95% CI [0.15,1.79],  = 0.30) complications.

CONCLUSION: Trainees involvement was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy, however, did not impact surgical outcomes for laparoscopic myomectomy.

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