Impact of case-specific learning goal on robotic-assisted surgery care delivery.

Abstract

Introduction: We hypothesize that resident's intraoperative case-specific learning goal may influence resident intraoperative autonomy and robotic-assisted surgery (RAS) surgical outcomes measured by operative time (OT), length of stay (LOS), direct cost (DC), and 30-day readmission (30R).

Methods: Valid resident operative performance evaluations, which includes case-specific learning goal selection (LGS) and degree of learning goal completion (LGC) metrics, of three outpatient RAS procedures-inguinal hernia, ventral hernia, and cholecystectomy-performed by PGY2-5 residents were collected. Cases in which residents served as bedside assistants were excluded. OT, LOS, DC, and 30R for matched cases were extracted from hospital records. Descriptive statistical analysis was applied.

Results: A total of 104 evaluations from 57 outpatient RAS cases were analyzed. Residents' overall permitted intraoperative autonomy was positively correlated with their LGS (0.66, p < 0.0001) and LGC (0.64, p < 0.0001). Overall LGS had minimal impact on OT, LOS, and DC. However, significant differences (all p < 0.05) in surgical outcomes were observed between different LGC scores: Compared to cases with an LGC score 5 (fully completed learning goal), cases with an LGC score 3 (partially completed learning goal) showed significantly longer LOS (8.00 h > 5.87 h) and OT (98.36 min > 74.49 min) as well as higher DC ($4471.84 > $3945.23). RAS cases with an LGC score 5 had a higher probability of 30R than those with an LGC score 3 (18.03% > 1.64%), though it was not significant. LGS also showed a similar trend.

Conclusions: Study findings suggest the case-specific learning goal may influence resident autonomy as well as LOS, OT, DC and 30R of outpatient RAS cases. Identifying an achievable learning goal upon a resident's competency level may enhance intraoperative training and RAS care outcomes.