Abstract
Background: The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training. Study Design: We queried the NSQIP database for 6 index laparoscopic surgical procedures performed during 2005-2008. Selected procedures require varying skill level (eg, appendectomy, cholecystectomy, gastric bypass, fundoplication, colectomy, and inguinal hernia), and 79,720 cases were identified. Preoperative, operative, and postoperative outcomes for each procedure were tabulated. Operative and postoperative outcomes assessed included operative time, hospital length of stay, mortality, morbidity, and return to the operating room. Initial analysis compared cases done with a resident present with cases done without residents. Subset analysis was done to determine possible differences in outcomes based on the level of resident participating, divided into Junior (PGY1-2), Senior (PGY3-5), or Fellow (PGY>5). Groups were scrutinized for both clinical and statistical differences. Results: Preoperative characteristics were similar between groups. Operative times were 20% to 47% longer with resident participation, with bigger differences seen in more basic procedures. Mortality and return to the operating room were not clinically different between the groups. Morbidity rates were higher in all procedures with resident participation. More senior residents were associated with longer operative times, without adverse impact on outcomes. Conclusions: Resident participation increases operative times for laparoscopic surgery considerably. Morbidity is statistically higher with resident participation but differences are unlikely to be clinically significant. Resident participation is a surrogate for the learning environment. These findings provide impetus for additional development of training techniques that occur outside the operating room.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 96-104 |
| Number of pages | 9 |
| Journal | Journal of the American College of Surgeons |
| Volume | 216 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2013 |
| Externally published | Yes |
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Keywords
- ACS
- American College of Surgeons
- lap appy
- lap chole
- lap colon
- lap fundo
- lap IH
- lap RYGB
- laparoscopic appendectomy
- laparoscopic cholecystectomy
- laparoscopic colectomy
- laparoscopic fundoplication
- laparoscopic inguinal hernia repair
- laparoscopic Roux-en-Y gastric bypass
- length of stay
- LOS
- Participant Use File
- PUF
ASJC Scopus subject areas
- Surgery
Cite this
Resident participation in index laparoscopic general surgical cases : Impact of the learning environment on surgical outcomes. / Davis, S. Scott; Husain, Farah; Lin, Edward; Nandipati, Kalyana C.; Perez, Sebastian; Sweeney, John F.
In: Journal of the American College of Surgeons, Vol. 216, No. 1, 01.2013, p. 96-104.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Resident participation in index laparoscopic general surgical cases
T2 - Impact of the learning environment on surgical outcomes
AU - Davis, S. Scott
AU - Husain, Farah
AU - Lin, Edward
AU - Nandipati, Kalyana C.
AU - Perez, Sebastian
AU - Sweeney, John F.
PY - 2013/1
Y1 - 2013/1
N2 - Background: The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training. Study Design: We queried the NSQIP database for 6 index laparoscopic surgical procedures performed during 2005-2008. Selected procedures require varying skill level (eg, appendectomy, cholecystectomy, gastric bypass, fundoplication, colectomy, and inguinal hernia), and 79,720 cases were identified. Preoperative, operative, and postoperative outcomes for each procedure were tabulated. Operative and postoperative outcomes assessed included operative time, hospital length of stay, mortality, morbidity, and return to the operating room. Initial analysis compared cases done with a resident present with cases done without residents. Subset analysis was done to determine possible differences in outcomes based on the level of resident participating, divided into Junior (PGY1-2), Senior (PGY3-5), or Fellow (PGY>5). Groups were scrutinized for both clinical and statistical differences. Results: Preoperative characteristics were similar between groups. Operative times were 20% to 47% longer with resident participation, with bigger differences seen in more basic procedures. Mortality and return to the operating room were not clinically different between the groups. Morbidity rates were higher in all procedures with resident participation. More senior residents were associated with longer operative times, without adverse impact on outcomes. Conclusions: Resident participation increases operative times for laparoscopic surgery considerably. Morbidity is statistically higher with resident participation but differences are unlikely to be clinically significant. Resident participation is a surrogate for the learning environment. These findings provide impetus for additional development of training techniques that occur outside the operating room.
AB - Background: The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training. Study Design: We queried the NSQIP database for 6 index laparoscopic surgical procedures performed during 2005-2008. Selected procedures require varying skill level (eg, appendectomy, cholecystectomy, gastric bypass, fundoplication, colectomy, and inguinal hernia), and 79,720 cases were identified. Preoperative, operative, and postoperative outcomes for each procedure were tabulated. Operative and postoperative outcomes assessed included operative time, hospital length of stay, mortality, morbidity, and return to the operating room. Initial analysis compared cases done with a resident present with cases done without residents. Subset analysis was done to determine possible differences in outcomes based on the level of resident participating, divided into Junior (PGY1-2), Senior (PGY3-5), or Fellow (PGY>5). Groups were scrutinized for both clinical and statistical differences. Results: Preoperative characteristics were similar between groups. Operative times were 20% to 47% longer with resident participation, with bigger differences seen in more basic procedures. Mortality and return to the operating room were not clinically different between the groups. Morbidity rates were higher in all procedures with resident participation. More senior residents were associated with longer operative times, without adverse impact on outcomes. Conclusions: Resident participation increases operative times for laparoscopic surgery considerably. Morbidity is statistically higher with resident participation but differences are unlikely to be clinically significant. Resident participation is a surrogate for the learning environment. These findings provide impetus for additional development of training techniques that occur outside the operating room.
KW - ACS
KW - American College of Surgeons
KW - lap appy
KW - lap chole
KW - lap colon
KW - lap fundo
KW - lap IH
KW - lap RYGB
KW - laparoscopic appendectomy
KW - laparoscopic cholecystectomy
KW - laparoscopic colectomy
KW - laparoscopic fundoplication
KW - laparoscopic inguinal hernia repair
KW - laparoscopic Roux-en-Y gastric bypass
KW - length of stay
KW - LOS
KW - Participant Use File
KW - PUF
UR - http://www.scopus.com/inward/record.url?scp=84871223079&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871223079&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2012.08.014
DO - 10.1016/j.jamcollsurg.2012.08.014
M3 - Article
VL - 216
SP - 96
EP - 104
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 1
ER -