Introduction: The emergence of the COVID-19 pandemic resulted in elective surgical closures beginning in March 2020. In the immediate 6-months after COVID-19 began, there was a significant reduction in national resident operative experience. Our objective is to evaluate the impact of COVID-19 on urology resident surgical experience the year before and after COVID-19 using a national surgical case log registry.
Methods: : Canadian national urology resident case log data (T-Res) was analyzed for the 2-year time period from March 15, 2019 – March 14, 2021 with respect to the 14 most commonly performed urological procedures. The 12-month time period prior to COVID-19 was compared to the 12-month time period after COVID-19. Data was analyzed from 11 residency programs with regular active users generating case logs over this time period. Total and specific case volumes per program and per resident user of the time period were analyzed. A paired Wilcoxon signed-rank test was used for comparison of mean cases pre- and post-COVID-19 with an alpha of 0.05 defined as significant.
Results: A total of 26,715 procedures were recorded over the 24-month period among 150 unique resident users in 11 training programs. In the 12-months prior to COVID-19, 11,906 procedures were logged while 14,809 procedures were logged in the 12-months after. Nationally, mean total case numbers per program (1082.4 vs. 1346.3; p=0.27) and per resident were not significantly reduced in the 12-months after COVID-19 when compared to 12-months prior (144.5 vs. 135.9; p=0.53). For specific surgeries by program, mean volumes per resident before and after COVID-19 were not significantly different including TURBT (18.5 vs. 19.4; p=0.66), TURP (11.3 vs. 11.7; p=0.72), PCNL (4.1 vs. 3.3; p=0.80), circumcision (6.9 vs. 5.9; p=0.25), hypospadias repair (0.9 vs. 0.6; p=0.39), hydrocelectomy (3.9 vs. 2.6; p=0.37), orchidopexy (4.2 vs. 4.1; p=0.99), ureteroscopy (18.6 vs. 21.3; p=0.53), stent insertion (17.7 vs. 16.7; p=0.77), radical prostatectomy (4.9 vs. 4.8; p=0.89), radical nephrectomy (3.6 vs. 4.0; p=0.75), partial nephrectomy (2.4 vs. 3.0; p=0.29), radical cystectomy (2.8 vs. 3.2; p=0.51), and cystolitholapaxy (3.1 vs. 2.5; p=0.48). While nationally overall case volumes were stable, 3/11 (27.3%) of programs continue to report a significant reduction in surgical volumes 1 year after COVID-19 even when adjusted for number of resident users.
Conclusions: Based on this national case log sample resident operative experience has rebounded one year after COVID-19. However, 27.3% of programs still report significantly reduced case volumes per resident after COVID-19 and this may warrant further examination to ensure focal deficiencies in training don’t arise.
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