Laparoscopic Roux-en-Y gastric bypass and the role of the surgical resident

Rovito, Peter; Kreitz, Keith; Harrison, T Daniel; Miller, M. Todd; Shimer, Richard

doi:10.1016/j.amjsurg.2004.06.041

Cited by 16 publications

(18 citation statements)

References 9 publications

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“…Although many studies of open operations have shown that resident participation does not have an appreciable influence on patient outcomes after accounting for higher patient illness severity in teaching hospitals, 2–4,7,9,10 those examining complex laparoscopic procedures have demonstrated increased complication rates with resident involvement. 13,17–20 Recent investigations of the Nationwide Inpatient Sample and the American College of Surgeons NSQIP registry showed higher risk-adjusted wound infection, deep vein thrombosis, and septic complication rates with resident or fellow involvement in bariatric procedures, even after accounting for patient illness severity. 17,21 Unlike those studies, we did not observe an increase in septic complications after risk adjustment, which can relate to the broader definition of septic complications used in those databases as compared with the more granular bariatric-surgery–specific outcomes recorded in the MBSC registry.…”

Section: Discussionmentioning

confidence: 99%

Effects of Resident Involvement on Complication Rates after Laparoscopic Gastric Bypass

Krell

Birkmeyer

Reames

et al. 2014

Journal of the American College of Surgeons

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BACKGROUND Although resident involvement has been shown to be safe for most procedures, the impact of residents on outcomes after complex laparoscopic procedures is not well understood. We sought to examine the impact of resident involvement on outcomes after bariatric surgery using a population-based clinical registry. STUDY DESIGN We analyzed 17,057 patients who underwent a primary laparoscopic gastric bypass in the 35-hospital Michigan Bariatric Surgery Collaborative from July 2006 to August 2012. Resident involvement was characterized at the surgeon level. Using hierarchical logistic regression, we examined the influence of resident involvement on 30-day complications, accounting for patient characteristics as well as hospital and surgeon case volume. To evaluate potential mediating factors for specific complications, we also adjusted for operative duration. RESULTS Risk-adjusted 30-day complication rates with and without residents were 13.0% and 8.5%, respectively (p < 0.01). Resident involvement was independently associated with wound infection (odds ratio [OR] = 2.06; 95% CI, 1.24–3.43) and venous thromboembolism (OR = 2.01; 95% CI, 1.19–3.40), but not with any other medical or surgical complications. Operative duration was longer with resident involvement (median duration with residents 129 minutes vs 88 minutes without; p < 0.01). After adjusting for operative duration, resident involvement was still independently associated with wound infection (OR = 1.67; 95% CI, 1.01–2.76), but not venous thromboembolism (OR = 1.73; 95% CI, 0.99–3.04). CONCLUSIONS Resident involvement in laparoscopic gastric bypass is independently associated with wound infections and venous thromboembolism. The effect appears to be mediated in part by longer operative times. These findings highlight the importance of strategies to assess and improve resident technical proficiency outside the operating room.

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Section: Discussionmentioning

confidence: 99%

Effects of Resident Involvement on Complication Rates after Laparoscopic Gastric Bypass

Krell

Birkmeyer

Reames

et al. 2014

Journal of the American College of Surgeons

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“…Furthermore, the procedure is deemed technically challenging, with the learning curve estimated to encompass 75 to 100 procedures, 17,18 and with lower surgical skill shown to correlate with adverse patient outcome. 19 Recent studies confirmed that supervised active resident participation in LRYGB did not lead to higher complication rates, 20,21 supporting the integration of the procedure into residency training. Only the first half of the LRYGB procedure, fashioning the jejunojejunostomy, was selected for this study, as trainees frequently perform these steps, which are common to a variety of laparoscopic procedures involving the creation of an entero-enteroanastomosis.…”

Section: Index Proceduresmentioning

confidence: 94%

Comprehensive Surgical Coaching Enhances Surgical Skill in the Operating Room

et al. 2015

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“…[19][20][21][22] Three authors (21%) divided the gastric bypass procedure into three steps (creating the pouch, gastro-enterostomy, entero-enterostomy) and taught residents one step at a time. 6,23,24 Three other studies described the education of a single step only (entero-enterostomy) or aimed their study at training of a single step. 20,25,26…”

Section: Level Of Evidencementioning

confidence: 99%