1. Roberto Hernandez-Irizarry, BS Benjamin Zendejas, MD, MSc Shahzad M. Ali, MD Christine Lohse, MS David R. Farley, MD NSQIP Data on Laparoscopic Inguinal Hernia Repairs: Are Residents Too Slow?

4. Outcomes? Multiple Centers Community Academic

5. Data National. Validated. Risk-adjusted Outcomes-based 30 day mortality/morbidity

6. Data: 2007-2009 10,391 patients had Lap IHR 4,168 had: CABG, Vasectomy… 6,223 Lap IHR only

7. Results Mean Age 53 yrs (16-90) OR Time 63 mins (6-303) 92% 8%

8. Results % Emergent <1 Bilateral 21 Recurrent 13 Resident 57

9. Operative Time Minutes Staff Alone PGY-1PGY-2PGY-3PGY-4PGY>5 45 50 55 60 65 70 75 P < 0.001 = 21 mins As PGY operative time P < 0.001 51 mins Staff Staff + Resident 72 mins

11. Duration of Stay Mean Median Staff 0.2 0 Staff + Resident 0.2 0 >1d >2d 1.53 1.64 Odds Ratio P<0.001

12. Duration of Stay OR >1d PGY P<0.05

14. Complications Infections Return to OR Nerve Injury Pneumonia Unplanned intubation UTI Dehiscence DVT/PE Renal Failure SepsisDeath Groin pain, Recurrence, Urinary Retention?

15. Staff 1.4% Staff + Res 1.7% PGY vs PGY: all p > 0.4 p = 0.3 Complications

16. Mayo vs World Mayo Academic Community Comp. Inpatient 0.9% 1.3% 0.9% 33% 10% 5%

17. Conclusions Solo staff surgeons are faster Shorter time with juniors vs senior

18. Conclusions Res + Staff: odds of longer hospital stay Sr. vs Jr. : odds of longer hospital stay

19. Conclusions NO Difference: - in M&M when residents “participate” - in M&M by resident PGY level

20. Weaknesses NSQIP: Academic over represented Complications Resident participation? TEP vs TAPP?

21. Final Thought OR Time 56 mins (6-303) 6 mins303 mins 1h2h3h4h5h

22. Roberto Hernandez-Irizarry, BS Benjamin Zendejas, MD, MSc Shahzad M. Ali, MD Christine Lohse, MS David R. Farley, MD NSQIP Data on Laparoscopic Inguinal Hernia Repairs: Are Residents Too Slow?