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Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes.
Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes.
- Source :
-
Journal of the American College of Surgeons [J Am Coll Surg] 2013 Jan; Vol. 216 (1), pp. 96-104. Date of Electronic Publication: 2012 Sep 19. - Publication Year :
- 2013
-
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.<br />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.<br />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.<br />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.<br /> (Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Child
Child, Preschool
Databases, Factual
Female
Humans
Infant
Laparoscopy mortality
Length of Stay statistics & numerical data
Logistic Models
Male
Odds Ratio
Operative Time
Postoperative Complications epidemiology
Postoperative Complications etiology
United States
Young Adult
General Surgery education
Internship and Residency methods
Laparoscopy education
Outcome and Process Assessment, Health Care
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1190
- Volume :
- 216
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 22999330
- Full Text :
- https://doi.org/10.1016/j.jamcollsurg.2012.08.014