Impact of surgical training and surgeon's experience on early outcome in kidney transplantation

Abstract

Purpose: The purpose of this study was to assess the impact of surgical training and surgeon's experience on surgical quality and early outcome parameters.

Methods: The outcomes of 184 deceased donor kidney transplant procedures were retrospectively reviewed. Intraoperative quality parameters, complication rates, and early outcome parameters were analyzed with respect to surgeon's experience. Surgeons were grouped according to their level of experience: trainees (n = 5), who were senior residents in their transplant rotation; low-experience surgeons (n = 4), who had an individual caseload of at least 30 supervised procedures; medium-experience surgeons (n = 5), who had an individual caseload of a minimum of 30 unsupervised (+30 supervised) procedures; and high-experience surgeons (n = 2), who had an individual caseload of more than 200 procedures.

Results: Surgical training was offered in 20 % of all cases. Surgeons with a high experience in kidney transplantation had a significantly lower warm ischemic time (30 versus 35 min, p = 0.01) and total operation time (135 versus 155 min, p = 0.43) as compared to the other study groups. However, this did not translate into a better outcome after transplantation. The complication rate and early outcome parameters such as length of hospital stay, serum creatinine at discharge, and graft and patient survival at 3 months post TX did not show any significant difference between the groups.

Conclusion: We conclude that hands-on training of residents in kidney transplantation is feasible and surgical experience can be safely gained within a staged surgical training program.