Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Scientific Session VI: General Urology, Clinical Practice and Academics Radical Cystectomy with Junior Residents: Longer Days, Equivalent Outcomes Joshua A. Linscott, MD, PhD , Randie E. White, MD, Stephen T. Ryan, MD, Moritz H. Hansen, MD, Jesse D. Sammon, DO, Matthew H. Hayn, MD Maine Medical Center, Portland, ME, USA Introduction: Radical cystectomy (RC) is known to be a highly morbid, complex, and technically challenging operation. At academic centers, the assistant is traditionally a chief or senior resident. Our institution has one urology resident per year and annually performs a total of 40-50 open or robotic radical cystectomies. This leads to junior residents (PGY2, PGY3) frequently participating as the primary assistant. Here we explore the impact of resident experience level on operative, hospital, and post-operative outcomes in RC. Materials & Methods: A single institution, prospectively maintained database identified 159 consecutive patients who underwent open or robotic RC from 2015-2019. Residents involvement was recorded in 154 cases. Operative time, estimated blood loss (EBL), intraoperative transfusion rate, length of stay (LOS), in hospital complication, complication within 90d, readmission at 90d, and urinary diversion complications (eg uretero-ileal stricture) were compared between junior (PGY2 & PGY3) and senior (PGY4 & PGY5) residents. Patient demographics including age, sex, BMI, preoperative neoadjuvant chemotherapy, andASAscorewere examined. Statistical analysis was performed with SPSS. Results: Over a 5-year period, junior residents assisted in 53 of 154 cases (34%) where a resident was involved. The number of cases done by PGY2, PGY3, PGY4, & PGY5 residents was 6, 47, 44, and 57, respectively. The percentage of open versus robotic cases was similar. There were no differences in examined patient demographics between groups. Cases with junior residents took an average of 29.1 min (CI 3.4-54.8, p=0.027) longer than when a senior resident was present. No other statistically significant differences between the two groups were seen when comparing EBL, intraoperative transfusion rate, surgical margin status, LOS, hospital complication, 90d complication, 90d readmission, or long-term urinary diversion complication ( Table 1 ). Conclusions: Radical cystectomy remains a challenging urologic operation demanding technical excellence. Our data suggests that participation by junior residents increases the length of operation by ~10% (29.1 min) but does not negatively impact patient outcomes. We propose this is explained by increased oversight from the attending surgeon, which allows junior residents to participate safely in an otherwise complex surgery. 62 Impact of Redeployment during the COVID-19 Pandemic on Urology Resident Education and Perceptions of the Equity of Redeployment Strategies Asha Ayub, MD 1 , Arthur Mourtzinos, MD 2 , Alireza Moinzadeh, MD 2 , Laura MacLachlan, MD 2 1 Tufts University School of Medicine, Boston, MA, USA; 2 Lahey Hospital and Medical Center, Burlington, MA, USA Introduction: During the height of the COVID-19 pandemic in spring 2020, residents and attending physicians fromvarious specialties, including urology were reassigned to COVID units. Didactic education was easily transitioned to virtual platforms, but the implications of decreased urologic surgical volumes on trainee education and attending and trainee perceptions of the redeployment require further investigation. Objective: To assess urology trainees and faculty redeployment and ascertain if there are any concerns about the long-term sequelae of redeployment on urology resident education. Materials &Methods: An anonymous 14-question survey was administered betweenMay 26, 2020 and June 30, 2020 to urology program staff and trainees at all accredited U.S. urology residency programs. Results: 81 faculty, residents, and fellows representing all the AUA sections participated in our survey. 90% of respondents stated their institution had a redeployment strategy. 59% of participants felt that their institution’s redeployment strategy was fair and equitable. However, a subgroup analysis comparing resident and attending responses, demonstrated a significant difference between faculty and residents who agreed that the redeployment plan was fair and equitable (67.9% vs 40.5%, respectively). The redeployment most often included residents (84%) and attendings (69%), followed by advanced practice providers (APPs) (63%) and fellows (52%). 48% of participants felt that deployed residents were still able to attend urologic education during redeployment. However, 31% of participants believed that COVID and redeployment will affect residents’ ability to reach the required surgical volume or competency goals for graduation. Conclusions: In response to the unprecedented COVID-19 pandemic, urology residency programs across the country sought to maintain trainee education in the midst of decreased surgical volumes and redeployment. Our study demonstrates a level of concern regarding the fairness of redeployment strategies, especiallywithin resident respondents, and their impact on urology resident competency that should be considered in future redeployment strategies should they be necessary. 61 31