Findings for benign hysterectomy procedures; operative time key mediator of relationship
TUESDAY, Aug. 2, 2016 (HealthDay News) — The correlation between trainee participation in benign hysterectomy and perioperative complications is influenced by surgical approach, according to a study published in the August issue of the American Journal of Obstetrics & Gynecology.
Emma L. Barber, M.D., from the University of North Carolina in Chapel Hill, and colleagues identified 22,499 patients undergoing hysterectomy for benign disease from the American College of Surgeons National Surgical Quality Improvement Program database. Perioperative complications, occurring from the start of surgery to 30 days postoperatively, were compared for surgeries with and without trainee involvement.
The researchers found that 42.1 percent of patients had trainee participation. Surgical approaches were vaginal, abdominal, and laparoscopic (22.7, 47.1, and 30.2 percent, respectively). The rate of major and minor complications was 3.2 and 7.2 percent, respectively. Trainee involvement correlated with major complications in vaginal hysterectomy, but not in laparoscopic or abdominal hysterectomy, in bivariable analysis. In vaginal, laparoscopic, and abdominal hysterectomy, trainee involvement was associated with minor complications. After adjustment for multiple variables, the correlation between trainee involvement in vaginal hysterectomy and major complications persisted (adjusted odds ratio, 1.45; 95 percent confidence interval, 1.03 to 2.40); the correlation was no longer significant after addition of operative time to the model (adjusted odds ratio, 1.26; 95 percent confidence interval, 0.89 to 1.80).
“Surgical approach influences the relationship between trainee involvement and perioperative complication,” the authors write. “Operative time is a key mediator of the relationship between trainee involvement and complication, and may be a modifiable risk factor.”
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