Trainee Involvement at Vaginal Hysterectomy: A Canadian Multicentre Retrospective Review

Abstract

Objectives

This study aimed to describe postgraduate obstetrics and gynaecology trainee involvement at vaginal hysterectomy (VH) compared with laparoscopic hysterectomy (LH) and laparoscopic-assisted vaginal hysterectomies, and to explore the impact of trainee involvement on VH surgical outcomes.

Methods

This was a multicentre retrospective cohort study of minimally invasive surgical (MIS) hysterectomies conducted from 2016 to 2022. Patient, surgery, and surgeon characteristics were compared between types of MIS hysterectomy, and factors associated with VH were identified through multivariable logistic regression analysis. Trainee presence at each type of MIS hysterectomy was documented. Analysis of VH surgical outcomes was performed with primary exposure as first-assistant training level (staff, fellow, resident).

Results

We included 5246 hysterectomies, with 1491 VHs, 3352 LHs, and 403 laparoscopic-assisted vaginal hysterectomies. Most hysterectomies involved at least 1 trainee (78.0%), less commonly at VH than at LH (76.8% vs. 79.5%, P < 0.05). When comparing VH with LH, more fellow involvement (48.3% vs. 35.1%, P < 0.001) and less resident involvement (60% vs. 66.8%, P < 0.001) was observed. Among hysterectomies that residents were present at, 30.2% of VH cases were performed with residents alone, as opposed to 42.4% of LH cases (P < 0.001). After adjusting for confounding factors, VHs with residents as the first assistant, compared with staff, had longer operative time (151 vs. 102 minutes, P < 0.001), higher estimated blood loss (200 vs. 100 cc, P < 0.001), and a higher rate of postoperative complications or readmission within 30 days of surgery (28.9% vs. 15.4%, P < 0.01).

Conclusions

Residents are less frequently involved at VH compared with LH. VH surgical outcomes were found to worsen when trainees were the first assistant as opposed to staff.