Surgical trainee impact on bariatric surgery safety

Abstract

Background Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) are commonly performed bariatric procedures that are associated with a significant learning curve. The effect of surgeon experience on perioperative outcomes and safety is established, but the effect of trainee participation remains unclear. The purpose of this study was to assess the impact of trainees on early perioperative safety of bariatric surgery. Methods Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for 2015 was used to identify non-revisional laparoscopic and robotic RYGB and SG procedures. Comparisons were made based on assistant level. Multivariable logistic and linear regression methodology was used to compare clinical outcomes. Results There were 35,354 laparoscopic RYGB, 2896 robotic RYGB, 79,717 laparoscopic SG, and 5449 robotic SG procedures examined. 21,257 (17%) and 11,322 (9%) of all procedures were performed with a resident or fellow, respectively. Fellow presence was independently associated with the development of complications for all procedure types except robotic SG when compared to non-trainee [odds ratio (OR) 1.31, 2.20, 1.28 for laparoscopic RYGB, robotic RYGB, and laparoscopic SG, respectively]. The most common events were urinary tract and superficial surgical site infections. This negative impact of fellow on overall complications was eliminated after accounting for operative duration. In laparoscopic SG, resident participation was associated with higher leak rate (OR 1.61), readmission (OR 1.18), re-intervention (OR 1.4), and complication rate (OR 1.32) compared to non-trainee, even after accounting for procedural duration. In robotic SG, there was no impact of trainee on outcomes. Conclusions Although fellow training is associated with higher overall complication rate, there is no such impact on major safety benchmarks, including leak rate and re-operation. In contrast, the impact of resident trainees on SG outcomes is substantial. Operative involvement of trainees in bariatric surgery leads to different outcomes based on trainee level and should be judiciously considered during the programmatic design of bariatric educational curricula.

Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

“…There are several limitations of this study. While the MBSAQIP data set is the most comprehensive bariatric database available, it is devoid of information that may identify surgeon training level and experience [12,[49][50][51]. Details of patient income level, insurance status, and geographic location are also absent from the dataset, and may provide additional information regarding socioeconomic factors.…”

Impact of bedside assistant on outcomes of robotic thyroid surgery

“…The Sx values were summed sequentially and then plotted as a graph using the equation: CUSUM = ΣSx. [ 14 ]…”

“…[ 13 – 16 ] Moreover, participation of trainees resulted in higher rates of anastomosis leakage, readmissions, re-interventions, and complications. [ 14 ] In contrast, Abu-Ghanem et al [ 17 ] found that assistant's experience levels had no influence on operative outcomes. The effects of bedside assistants on surgical outcomes for thyroid surgery have remained unclear.…”

Conversion from mini bypass to laparoscopic Roux en Y gastric bypass in an emergency setting: Case report and literature review

“…Many surgical procedures have been developed, however the principles that govern the standard procedures today follow two fundamental ideas, limiting gastric capacity (restrictive) and altering the absorption of the small intestine (malabsorptive) [ 5 ]. It is almost a rule that higher complexity procedures are associated with greater weight loss and better resolutions of most of the comorbidities such as diabetes and hypertension [ [24] , [25] , [26] ].…”