J. K. Ewing1, M. T. LeCompte2, S. Walia1, A. C. Sayce1, D. E. Pereira1, J. R. Robinson1, K. Terhune1, D. Shaffer3, R. C. Forbes3 1Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 2Washington University,Department Of Surgery, Division Of Hepatobiliary-Pancreatic & GI Surgery,St. Louis, MO, USA 3Vanderbilt University Medical Center,Department Of Surgery, Division Of Kidney And Pancreas Transplantation,Nashville, TN, USA
Introduction: Surgical trainees’ operative proficiency improves with experience, but it is unclear how cumulative operative experience affects trainees’ ability to learn and perform specific operative procedures. We aimed to determine if resident trainees’ cumulative operative experience, reflected by time within postgraduate training year (PGY), affects key time metrics in kidney transplant.
Methods: We performed a retrospective cohort study of all living donor kidney transplants at a tertiary care academic hospital from 2006-2016. We included all procedures performed by a single attending surgeon with PGY3 residents. Trainees participated in all operative steps and sewed the lateral half of both vascular anastomoses. Multiple linear regression was used to determine if vascular anastomosis or operating room (OR) time varied between operations performed by residents early in PGY3 (July-December) versus late in PGY3 (January-June). Analyses controlled for recipient body mass index (BMI), gender, operative site laterality, and allograft laterality.
Results: Of the 355 included transplants, 179 (50.4%) were performed early in PGY3 and 176 (49.6%) were performed late in PGY3. Anastomosis time (mean+/-SD ) was 20.0+/-3.1 minutes and total OR time was 198+/-38 minutes. There was no significant difference in anastomosis time between the early (20.2 minutes) versus late (19.8 minutes) groups (p = 0.466). Anastomosis time was shorter for right versus left donor kidneys (p = 0.002) and shorter in recipients with lower BMI (p = 0.020). Total OR time trended towards (p = 0.051) shorter times in the late group (195 minutes) versus the early group (201 minutes), but this did not meet statistical significance. Total OR time was not significantly affected by recipient gender, BMI, allograft laterality, or operative site laterality.
Conclusion: Vascular anastomosis and total OR times were similar in kidney transplants performed by residents early versus late in PGY3, suggesting that cumulative operative experience may not strongly affect performance of specialized skills. More work is needed to determine which operations and techniques are most affected by cumulative operative experience and to characterize the learning curve for specific surgical skills. These findings support the need to assess skilled procedural learning with competency-based outcome measurements rather than cumulative training time in surgical education.
