EXTIRPATIVE RENAL SURGERY VOLUME IN TRAINING - DIFFERENT ROADS TO THE (SAME?) DESTINATION
Amanda F. Saltzman, MD, Madison Lyon, BS, Randall Meacham, MD, Nicholas G. Cost, MD.
University of Colorado, Aurora, CO, USA.
Introduction & Objective: Pediatric extirpative renal surgery is performed by both pediatric urologists (PU) and pediatric surgeons (PS). The limited data available on the topic demonstrate for patients with malignancy, PU tend to operate on older patients, but apparently have no difference in short-term complications compared to PS. The objective of our study is to estimate the overall extirpative renal surgery training volume by PU and PS. We hypothesize that when comparing PU and PS, PU have a greater overall training volume that is heavily weighted towards residency, while PS receive virtually all such training during fellowship.
Methods: We analyzed Accreditation Council for Graduate Medical Education (ACGME) case log data from 2013-2016 for surgery residents (Sres), urology residents (Ures), pediatric surgery fellows (Sfel) and pediatric urology fellows (Ufel). Case log information for all levels of participation over all case categories that could potentially offer extirpative renal surgery volume were recorded. Volume was estimated using the mean number of included cases during residency, fellowship and the sum was used to estimate total PU and PS training volume. Volume between groups was compared using a student’s t-test.
Results: Case logs were included for 4447 residents (4259 Sres, 840 Ures) and fellows (188 Sfel, 71 Ufel). Over the 3 years studied, mean PU volume was 113.1 (SD 62.2), which was higher than the mean PS volume of 17.3 (SD 10.3), p<0.001. For PU, more extirpative renal surgeries were performed during residency than fellowship (p<0.001). For PS the opposite was true, with more extirpative renal surgeries being performed during fellowship (p<0.001). When examining fellow training only, there was no difference in training volume between Ufel and Sfel (p>0.05), despite surgery fellowships being twice as long (see table 1).
Conclusions: While similar short-term outcomes are reported for extirpative renal surgery for malignancy for PU and PS, case volume during training is significantly different. Review of ACGME data indicate that PU have more overall experience, with most gained during residency. There is no difference in the training volume for Ufel and Sfel. Further study into the potential for these training differences to affect long-term outcomes is necessary.
Table - Comparison of extirpative renal surgery training volume between PU and PS
| Overall extirpative renal surgery training volume | |||
| Year | PU mean | PS mean | p-value |
| 2013-2014 | 110.4 | 17.1 | <0.001 |
| 2014-2015 | 112.8 | 17.2 | <0.001 |
| 2015-2016 | 116.2 | 17.5 | <0.001 |
| Total Study Period 2013-2016 | 113.1 | 17.3 | <0.001 |
| Fellowship extirpative renal surgery training volume | |||
| Year | Ufel mean | Sfel mean | p-value |
| 2013-2014 | 11.6 | 14 | 0.118 |
| 2014-2015 | 11.4 | 14 | 0.0525 |
| 2015-2016 | 12 | 14.5 | 0.0854 |
| Total Study Period 2013-2016 | 11.7 | 14.2 | 0.0772 |
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