Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents

Siam, Baha; Al-Kurd, Abbas; Simanovsky, Natalia; Awesat, Haitham; Cohn, Yahav; Helou, Brigitte; Eid, Ahmed; Mazeh, Haggi

doi:10.1001/jamasurg.2017.0578

Cited by 50 publications

(34 citation statements)

References 22 publications

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“…Additionally, it was seen that LAs performed by residents under supervision, in fact, resulted in similar outcomes. [51] Lastly, the final limitation was the observed differences in appendiceal stump closure between groups. We were not able to provide data on the rationale for using any particular method of stump closure, for example endostapler vs. endoloop/clip; however, it is likely that the decision was based on the surgeon's discretion and intraoperative findings.…”

Section: Discussionmentioning

confidence: 99%

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Pędziwiatr

Lasek

Wysocki

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA. METHODS: The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni-and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis. RESULTS: In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were:

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Section: Discussionmentioning

confidence: 99%

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Pędziwiatr

Lasek

Wysocki

et al. 2018

Ulus Travma Acil Cerrahi Derg

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“…Thus, the authors concluded that it is safe to allow surgical residents to perform appendectomies done under standard conditions to be safe. This is balanced with the residents' ability to recognize and engage an attending should such a clinical situation arise [75]. Other studies have similarly demonstrated safety in resident performed appendectomies with minimal attending supervision [76][77][78][79].…”

Section: Outcomes Associated With Autonomymentioning

confidence: 99%

“…Several published studies have studied outcomes associated with appendectomies performed by general surgery residents compared to those performed by senior surgeons (attendings). One such study by Siam et al [75] demonstrated no difference in outcomes for those appendectomies performed by senior general surgeons and general surgery residents. In this large retrospective study from Israel, over 1600 appendectomies were evaluated with over 500 of those performed alone by a general surgery resident.…”

Section: Outcomes Associated With Autonomymentioning

confidence: 99%

Resident Autonomy

Cooper¹,

Allen²

2019

Contemporary Topics in Graduate Medical Education

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Autonomy in medical training is required to develop independent and competent physicians. The way in which this incremental level of independence is granted to a trainee must be thoughtful and deliberate to ensure appropriate supervision and patient safety. Theories that support the role of autonomy will be introduced and discussed in this chapter. Ethical considerations that describe the implications of balancing the necessary independence for trainees and an attending physician's responsibility to the patient and the patient's safety will also be considered. The level of autonomy that is granted is the responsibility of both the attending physician and trainee so that it is not only appropriate but also wellearned. There are multiple tools that may be used to objectively measure one's competence and necessary level of autonomy based on performance that will be discussed within this chapter. Finally we will demonstrate that encouraging and striking the balance of supervision and autonomy may be done safely with appropriate patient outcomes and trainee development into independent physicians. These outcomes will help to encourage autonomy amongst medical trainees, no matter one's specialty, to train and develop competent, independent physicians of the future.

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“…Colecistectomía laparoscópica versus asistida por robot: un estudio de cohorte retrospectiva 64 . El objetivo de este estudio fue evaluar los resultados de colecistectomía laparoscópica y robótica.…”

Section: Estudios De Cohortes Retrospectivas O Históricasunclassified

“…Ambos grupos eran comparables en términos de edad, proporción de sexos, indicación de colecistectomía, e índice de masa corporal. De los resultados, destaca que en ambas cohortes se verificaron tiempos quirúrgicos, pérdidas hemáticas, número de conversiones a cirugía abierta, desarrollo de complicaciones mayores y tiempos de hospitalización similares (todos con valores de p > 0, 9) 64 .…”

Section: Estudios De Cohortes Retrospectivas O Históricasunclassified

Estudios de cohortes. 1ª parte. Descripción, metodología y aplicaciones

et al. 2019

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Los estudios de cohortes (EC), son estudios de carácter longitudinal, observacional y analíticos. Corresponden a uno de los diseños más utilizados en investigación clínica, aportando altos niveles de evidencia, según el tipo de escenario en los que se aplique.Los EC tienen como objetivos, determinar asociación entre un factor de exposición y el desarrollo de alguna enfermedad o evento de interés, a partir de la estimación de riesgos; conocer la historia natural o el curso clínico de una enfermedad o de un evento de interés; determinar supervivencia; estudiar factores protectores y pronósticos.Los EC tienen diversas aplicaciones, por ejemplo: investigación de brotes epidemiológicos, estudios de causalidad, evaluación de intervenciones educacionales, etc.Teóricamente, la mejor aproximación es mediante un estudio de cohortes prospectivas; sin embargo, suelen exigir largos períodos de tiempo de seguimiento para obtener resultados útiles; por lo tanto, se puede recurrir a otras estrategias, como a los estudios retrospectivos y otros, que pueden resultar más factibles respecto de recursos y tiempos de seguimiento.El objetivo de este manuscrito fue generar un documento de estudio referente a descripción, metodología y aplicaciones de los EC en ciencias de la salud.

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Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents

Abstract: This study demonstrates that unsupervised surgical residents may safely perform appendectomies, with no difference in postoperative early and late complication rates compared with those performed in the presence of an SGS.

Cited by 50 publications

References 22 publications

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Complicated appendicitis: risk factors and outcomes of laparoscopic appendectomy – results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Resident Autonomy

Estudios de cohortes. 1ª parte. Descripción, metodología y aplicaciones

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