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Objective: To evaluate the impact of a urologic fellowship on physician case-volume and immediate patient outcomes, and to assess predictors of undergoing a robotic-assisted partial nephrectomy by a fellowship-trained (FT) urologist.Methods: We retrospectively reviewed all robotic (ICD-9 17.4) partial nephrectomies (PN; ICD-9 55.4) reported in the Statewide Planning and Research Cooperative Systems (SPARCS) database of New York State (NYS) from 2009 to 2014. Perioperative outcomes assessed included length of stay, 30-day readmission rates, 90-day readmission rates, and complication rates. Pearson chi-square tests were used to compare categorical variables, and unpaired Student t tests were used to assess continuous variables.Results: FT urologists performed 2199 (56%) RAPN during the study period, and nonfellowship trained (NFT) urologists completed 1700 (44%) RAPN. FT urologists performed more RAPN in teaching hospitals than NFT urologists (23% vs 7%). The average surgical volume per year for a FT urologist conducting RAPN was 9.6 ± 2.2 cases/y. NFT urologists had an average surgical volume of 7.2 ± 1.5 cases/y (P = <.0001). No significant difference was found in length of stay, 30- or 90-day readmission rate, or complication rate between the groups. RAPN conducted at teaching hospitals were more likely to be conducted by FT urologists. Patients who were self-payers were less likely to have a RAPN by FT urologists.Conclusion: There were no differences for RAPN perioperative outcomes between FT urologists and their NFT peers. FT urologists perform a higher case-volume of RAPN in NYS, and this trend is increasing. [ABSTRACT FROM AUTHOR]

Background: General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume.Methods: The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models.Results: Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44-0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68-0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78-0.95, p < 0.001).Conclusions: For patients undergoing colectomy/proctectomy, in-hospital mortality decreased when the operation was performed by a CR surgeon even after accounting for hospital and surgeon volume. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of a dedicated research year on the h-indices of residents and the pursuit of fellowship within a heterogeneous group of urology programs. We previously demonstrated that urology residents with a dedicated research year produce more than 2 times the number of publications than their counterparts in 5-year programs. However, we did not give consideration to the impact of these publications.Materials and Methods: We obtained information on the publication output and pursuit of fellowship of graduates from the New York Section urology residency programs from 2009 to 2013. Data on peer-reviewed publications were obtained by PubMed query and h-index was documented from the Scopus database.Results: During the 5-year study period, 148 individuals (116 M, 32 F) graduated from New York Section urology programs. The mean h-index was 4.6 for residents in 5-year programs compared with 8.1 for those in 6-year programs (P < .001). Residents with a dedicated research year were more likely to pursue fellowship training (79.3% vs 58.8%, P = .023) with no difference in the pursuit of accredited fellowship programs. Those residents who went on to fellowship training had a significantly higher h-index (6.2 vs 3.6, P = .001).Conclusion: Urology residents with a dedicated research year have almost 2 times the h-indices of their counterparts. Residents who pursue fellowship training also have higher h-indices. Residents who completed a dedicated research year were more likely to pursue fellowship training, although the accreditation status of these programs was variable. [ABSTRACT FROM AUTHOR]

N/A, Narrative Medicine Article. [ABSTRACT FROM AUTHOR]