The Association Between Resident Participation and Hysterectomy Outcomes in Morbidly Obese Patients

Abstract

Objective:

The purpose of this study was to identify the effect of resident participation in hysterectomy on perioperative complications in morbidly obese patients.

Materials and Methods:

We randomly selected 225 patients with body mass index >40 kg/m² who underwent hysterectomy at University of North Carolina (UNC) Health Care between April 2014 and March 2018. We compared 108 patients with resident participation to 117 patients with no resident participation. We compared intraoperative and 30-day postoperative complications, which were categorized as minor (Clavien–Dindo grades 1 and 2) or major (Clavien–Dindo grade 3 and above).

Results:

There was a higher proportion of both obesity-related medical comorbidities (80.6% vs. 53.9%, p < 0.01) and nonobesity-related comorbidities (44.4% vs. 30.8%, p = 0.03) in the group with resident participation. Operative time was longer in the resident participation group (241.6 minutes compared with 172.9 minutes, p < 0.01). The resident participation group had a higher frequency of intraoperative hemorrhage or transfusion (5.6% vs. 0%, p = 0.01) and surgical site complication (7.4% vs. 0.9%, p = 0.02). After adjusting for demographic and surgical characteristics known to increase case complexity, we found a higher odds of any intraoperative complication in the resident participation group (adjusted odds ratio [aOR] 4.08; 95% confidence interval [CI], 1.14–14.56) and minor complications (aOR 2.56; 95% CI, 1.07–6.13). There was no significant difference in major complications between groups (aOR 1.88; 95% CI, 0.47–7.53).

Conclusion:

We found an increased odds of any intraoperative complication and minor perioperative complications among morbidly obese patients undergoing hysterectomy with resident participation. We did not find a difference in major complications. (J GYNECOL SURG 37:297)