Introduction: Surgical resident autonomy is critical for transition to confidence and transition to independent practice post training. This study examines the degree of urology resident autonomy at the VA hospitals in performing penile prosthetic surgery.
Methods: The VA Surgical Quality Improvement Program (VASQIP) was queried for penile prosthesis insertion and removal procedures between 2004 to 2019 at teaching VA hospitals. VASQIP does not track all penile prosthetic procedures. This data was then compared with the five most commonly resident performed non-penile prostheses cases within the database (transurethral resection of prostate, transurethral resection (small, medium, or large tumor), GreenLight laser of prostate, hydrocelectomy, and ureteral stent placement). The cases were stratified by attending supervision: attending as primary surgeon (AP), attending and resident (AR), resident as primary surgeon with the attending not scrubbed (RP). Primary outcome was rate of resident involvement. Secondary outcomes were 30-day mortality and morbidity within the prosthetic procedures by supervision categories. Statistics was performing using Pearson’s Chi Squared.
Results: 881 penile prosthesis implantation and removal cases were identified from 2004 to 2019. Of these, 13.2% were AP, 78.5% were AR, and 8.3% were RP compared to the most common procedures (n=127,757) which showed that 33.7% were AP, 40.6% were AR, and 25.7% were RP (p < 0.001). Comparison of AP, AR, and RP penile prostheses demonstrated no statistically significant increase in 30-day all-cause mortality or complications (Table 1).
Conclusions: Within VA hospitals, penile prostheses surgeries are performed by residents without an attending scrubbed less frequently than the most commonly performed urological surgeries. The sensitive and costly nature of implanting prostheses and the higher stakes of post-surgical infection may influence this trend. The latter may affect the residents’ comfort level independently performing these operations after graduation.
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