Morbidity and mortality of urological procedures: an analysis of outcomes according to residents’ experience

Postoperative complications are critical indicators of surgical quality and safety. Evaluating these outcomes in teaching hospitals is essential for both clinical care and residency training, particularly when structured data collection is limited. To evaluate postoperative complication rates using the Clavien-Dindo classification in urologic surgeries performed within a residency training program at a Brazilian tertiary university hospital, considering residents’ educational progress. This retrospective cohort study included patients undergoing urologic surgeries (conventional, endoscopic, or laparoscopic) between March 2022 and December 2023 in the public health system. Surgeries were grouped by the first and second semesters in each year to evaluate the clinical differences associated with residents’ educational progress. Postoperative complications within 30 days were classified using the Clavien-Dindo system. Surgical outcomes were described and compared between semesters using Chi-square and Mann-Whitney U tests. A total of 1,036 urological surgeries were evaluated, with a predominance of male patients (71.7%) and at least one comorbidity present in 81.5% of the cases, with hypertension being the most prevalent (50%). The number of procedures was similar between the first ( n = 545) and second ( n = 491) semesters. Most patients were classified as having no complications (90% vs. 87%). Minor complications (Clavien I–III) occurred in 8% and 12% of the cases, respectively, while major complications (Clavien IV–V) were rare (0.5% vs. 1%). Endoscopic procedures were the most frequently performed (55.4%) and showed the lowest rates of major complications. Conventional and laparoscopic surgeries showed minor variations in outcomes without a relevant clinical impact. There was a significant increase in overall complications during the second semester (15.1% vs. 8.8%; p = 0.002), mainly due to the higher rate of surgical site infections (5.9% vs. 2.0%; p = 0.002) and events classified as “other” (6.9% vs. 2.9%; p = 0.003). The average length of hospital stay was shorter during this period (6.4 vs. 8.8 days; p = 0.002). When outcomes were grouped as favorable (no complications or Clavien I–III) and unfavorable (Clavien IV–V), 99% of the procedures had a favorable outcome, with no statistically significant difference between the semesters ( p = 0.201). Complication tracking and multidisciplinary reviews effectively supported the quality and safety of surgical training. No significant difference in complication rates was observed between procedures performed by residents at earlier and later stages of training, reflecting the protective role of structured supervision and progressive case allocation within the program.