ABSTRACT
Minimally invasive gender-affirming procedures (MIGAPs), which aim to align gender identity and expression for transgender and gender-nonbinary patients in a way that is safe, effective, and semipermanent or reversible, are gaining in popularity. This article assesses the current amount of trainee exposure in clinic and didactic sessions in core procedural specialties nationwide via survey study of program directors. Low exposure of residents and fellows to MIGAPs was observed overall and a lack of procedure-specific education. In an effort to provide excellent patient care, promote cultural humility, and improve patients' quality of life, further education regarding these procedures is necessary.
Subject(s)
Curriculum , Dermatology/education , Education, Medical, Graduate/methods , Sex Reassignment Procedures , Surgery, Plastic/education , Body Contouring/education , Cosmetic Techniques , Dermal Fillers/therapeutic use , Education, Medical, Graduate/statistics & numerical data , Faculty, Medical , Hair Removal , Humans , Laser Therapy , Neuromuscular Agents/therapeutic use , Surveys and Questionnaires , Transgender PersonsABSTRACT
Given the rising popularity in body-contouring procedures (BCPs) in the United States, it is important to assess the currently unknown association between resident involvement and postoperative complications. As such, the aim of this study was to evaluate the impact of resident involvement on outcomes in BCPs using a large national database. METHODS: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed (2006-2012) to identify patients undergoing BCPs, using relevant Current Procedural Terminology codes. Outcome measures included postoperative complications, hospital length of stay, and operation time.Multivariate regression models were used to assess the impact of resident involvement and resident experience on outcomes. RESULTS: A total of 9638 cases were identified, of which 3311 involved resident participation.Resident involvement was associated with significantly higher rates of complications (7.8% vs 4.4%; P = 0.003) and longer operation times (180.7 vs 171.9 minutes; P = 0.005). For each year increase of resident postgraduate year, there was a significant decrease in odds of complications (odds ratio, 0.906; P = 0.013) and operative time (-2.7 minutes; P = 0.001). CONCLUSIONS: Resident involvement in BCPs was associated with an increased rate of overall complications in a large, national database. However, the clinical significance of these outcomes may be debated. Increased postgraduate year experience as a surgical resident was inversely associated with overall complications. Guided resident autonomy and earlier exposure to BCPs could lead to an optimization of clinical outcomes and resident education.
Subject(s)
Body Contouring/education , Clinical Competence , Mammaplasty/education , Quality Improvement , Registries , Adult , Aged , Body Contouring/methods , Cohort Studies , Education, Medical, Graduate/methods , Female , Humans , Internship and Residency/methods , Logistic Models , Male , Mammaplasty/methods , Middle Aged , Multivariate Analysis , Odds Ratio , Operative Time , Professional Autonomy , Retrospective Studies , United StatesABSTRACT
BACKGROUND: An increasing number of patients need reconstructive surgery after massive weight loss. The hypothesis was that surgical experience together with standardised management guidelines significantly decreases early complication rates after abdominoplasty for massive weight loss. The primary aim was to assess the 30-day complication rate after abdominoplasty following increased surgical training and experience. The secondary aim was to assess whether optimised management guidelines have an impact on the complication rate and patient safety. METHODS: The outcome of 69 consecutive abdominoplasties operated by surgeons in 2011 (Group A) and 70 consecutive patients operated by plastic surgeons in 2010-2012 (Group B) was compared. Another Group of 70 consecutive patients operated by surgeons in 2013-2014 (Group C) was assessed since standardised guidelines for pre- and post-operative treatments and refinement of surgical technique had been introduced. The same surgeons participated in operations of Groups A and C. χ 2-test and Fisher's exact test were applied to dichotomous data. Logistic regression test and ANOVA were used. RESULTS: Group C had more comorbidities and was significantly older. 48 patients in Group A (70%), 31 in Group B (44%) and 13 patients in Group C (19%) had early complications. A significantly decreased rate of complications occurred with improved guidelines and surgical training and experience. (A vs. C p < 0.001 and A vs. B p = 0.008). CONCLUSIONS: Our results indicate that the rate of early complications after abdominoplasty for massive weight loss can be significantly reduced with improved surgical experience and standardised management guidelines. Registered at Clinical Trial.gov (ID: NCT02679391).
