TY - JOUR
T1 - The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections
AU - Ejaz, Aslam
AU - Spolverato, Gaya
AU - Kim, Yuhree
AU - Wolfgang, Christopher L.
AU - Hirose, Kenzo
AU - Weiss, Matthew
AU - Makary, Martin A.
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined. Methods We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006 and 2012 using the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models were constructed to determine any association between resident participation and surgical outcomes. Results Pancreatic resections (n = 16,045; 62.9%) were more common than liver resections (n = 9,466; 37%). Residents participated in the majority of cases (n = 21,857; 86%), with most involvement at the senior level (postgraduate year 3, n = 21,147; 97%). Resident participation resulted in slightly longer mean operative times (hepatic, 9 minutes; pancreatic, 22 minutes; both P <.01). Need for perioperative transfusion, hospital duration of stay, and reoperation rates were unaffected by resident participation (all P >.05). Resident participation resulted in a higher risk of overall morbidity (odds ratio [OR], 1.14; 95% CI, 1.05-1.24; P =.001), but not major morbidity (OR, 1.05; 95% CI, 0.93-1.20; P =.40) after liver and pancreas resection. Resident participation resulted in lower odds of 30-day mortality after liver and pancreas resections (OR, 0.75; 95% CI, 0.60-0.94; P =.01). Conclusion Although resident participation resulted in slightly longer operative times and a modest increase in overall complications after liver and pancreatic resection, other metrics such as duration of stay, major morbidity, and mortality were unaffected. These data have important implications for educating patients regarding resident participation in these complex cases.
AB - Background Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined. Methods We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006 and 2012 using the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models were constructed to determine any association between resident participation and surgical outcomes. Results Pancreatic resections (n = 16,045; 62.9%) were more common than liver resections (n = 9,466; 37%). Residents participated in the majority of cases (n = 21,857; 86%), with most involvement at the senior level (postgraduate year 3, n = 21,147; 97%). Resident participation resulted in slightly longer mean operative times (hepatic, 9 minutes; pancreatic, 22 minutes; both P <.01). Need for perioperative transfusion, hospital duration of stay, and reoperation rates were unaffected by resident participation (all P >.05). Resident participation resulted in a higher risk of overall morbidity (odds ratio [OR], 1.14; 95% CI, 1.05-1.24; P =.001), but not major morbidity (OR, 1.05; 95% CI, 0.93-1.20; P =.40) after liver and pancreas resection. Resident participation resulted in lower odds of 30-day mortality after liver and pancreas resections (OR, 0.75; 95% CI, 0.60-0.94; P =.01). Conclusion Although resident participation resulted in slightly longer operative times and a modest increase in overall complications after liver and pancreatic resection, other metrics such as duration of stay, major morbidity, and mortality were unaffected. These data have important implications for educating patients regarding resident participation in these complex cases.
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U2 - 10.1016/j.surg.2015.01.027
DO - 10.1016/j.surg.2015.01.027
M3 - Article
C2 - 26003913
AN - SCOPUS:84937513757
SN - 0039-6060
VL - 158
SP - 323
EP - 330
JO - Surgery
JF - Surgery
IS - 2
ER -