Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon

Anyomih, Theophilus Teddy Kojo; Jennings, Thomas; Mehta, Alok; O’Neill, J. Robert; Panagiotopoulou, Ioanna; Gourgiotis, Stavros; Tweedle, Elizabeth; Bennett, John M.; Rjo., Davies; Simillis, Constantinos

doi:10.1016/j.amjsurg.2022.07.006

Cited by 3 publications

(1 citation statement)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Efforts to enhance operating room efficiency in the healthcare sector are integral to optimizing the use of valuable resources while maintaining patient safety. While resident involvement in surgical cases may increase operative times [ 1 ], some studies suggest that patient safety is not compromised by the presence of residents or fellows during surgical procedures [ 2 – 6 ]. In contrast, analysis of the 2005–2010 Surgeons National Surgical Quality Improvement Program database identified elevated complications (wound issues, pulmonary complications, and venous thromboembolism) in emergency procedures involving trainees [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of an anesthesia residency teaching service on anesthesia-controlled time and postsurgical patient outcomes: a retrospective observational study on 15,084 surgical cases

Lynch,

Mongan,

Hoefnagel

2024

Patient Saf Surg

View full text Add to dashboard Cite

Background Limited data exists regarding the impact of anesthesia residents on operating room efficiency and patient safety outcomes. This investigation hypothesized that supervised anesthesiology residents do not increase anesthesia-controlled or prolonged extubation times compared to supervised certified registered nurse anesthetists (CRNA)/certified anesthesiologist assistants (CAA) or anesthesiologists working independently. Secondary objectives included differences in critical outcomes such as intraoperative hypotension, cardiac and pulmonary complications, acute kidney injury, and mortality. Methods This retrospective single-center 24-month (January 1, 2020- December 31, 2021) cohort focused on primary outcomes of anesthesia-controlled times and prolonged extubation (>15 min) with additional assessment of secondary patient outcomes in adult patients having general anesthesia with an endotracheal tube or laryngeal mask airway for elective non-cardiac surgery. The study excluded sedation, obstetric, endoscopic, ophthalmology, and non-operating room procedures. Procedures were divided into three groups: anesthesiologists working solo, anesthesiologists supervising residents, or anesthesiologists supervising CRNA/CAAs. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes. Results A total of 15,084 surgical cases met the inclusion criteria for this study for the three different care models: solo anesthesiologists (1,204 cases), anesthesiologist/resident pairing (3,146 cases), and anesthesiologist/CRNA/CAA (14,040 cases). Before multivariate analysis, the resident group exhibited longer anesthesia-controlled times (median, [interquartile range], 26.1 [21.7–32.0], p < 0.001), compared to CRNA/CAA (23.9 [19.7–29.5]), and attending-only surgical cases (21.0 [17.9–25.4]). After adjusting for covariates in a general linear regression model (age, BMI, ASA classification, comorbidities, arterial line insertion, surgical service, and surgical location), there were no significant differences in the anesthesia-controlled times between the provider groups. Prolonged extubation times (>15 min) were significantly less common in the anesthesiologist-only group compared to the other groups (p < 0.001). Despite these time differences, there were no clinically significant differences among the groups in postoperative pulmonary or cardiac complications, renal impairment, or the 30-day mortality rate of patients. Conclusion Anesthesia residents do not increase anesthesia-controlled operating room times or adversely affect clinically relevant patient outcomes compared to anesthesiologists working independently or supervising certified registered nurse anesthetists or certified anesthesiologist assistants.

show abstract

Section: Introductionmentioning

confidence: 99%

The impact of an anesthesia residency teaching service on anesthesia-controlled time and postsurgical patient outcomes: a retrospective observational study on 15,084 surgical cases

Lynch,

Mongan,

Hoefnagel

2024

Patient Saf Surg

View full text Add to dashboard Cite

show abstract

Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme

Skjold-Ødegaard,

Ersdal,

Assmus

et al. 2024

Surg Endosc

View full text Add to dashboard Cite

Background Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon’s experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees. Methods A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees’ overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A “Challenging” procedure was defined as a combination of either/or “perforation” and “difficult”. Trainees who had performed > 30 appendectomies were defined as “experienced”. The trainees were asked if they had used simulation or web-based tools the week prior to surgery. Results 142 procedure evaluation forms were included of which 19 (13%) were “perforated”, 14 (10%) “difficult” and 24 (17%) “Challenging”. Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0–75.6). Experienced trainees performed “proficient” more often than non-experienced (OR 34.5, 95% CI 6.8–176.5). “Difficult” procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0–0.9). In “Challenging” procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1–0.9). The procedures assessed as “difficult” had significantly longer operating time with a median (IQR) of 90 (75–100) min compared to 59 (25–120) min for the non-difficult (p < 0.001). Conclusion Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a “difficult” procedure had most overall impact on proficiency evaluation. Graphical Abstract

show abstract

Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis

Usman,

Akbar,

Mukhtar

et al. 2024

Dev. med. life sci.

View full text Add to dashboard Cite

Background: Post-operative medical complications are very common in patients with gangrenous nonperforated appendicitis, especially surgical site infections (SSIs). Currently no conclusive answers on the relative benefits of immediate vs delayed wound clear therefore a comparison is essential. Objectives: In order to compare the results of immediate versus delayed wound closure in patients with gangrenous appendicitis who underwent appendectomy, SSIs, wound healing, and general postoperative recovery will be assessed. Methodology: The present study is a retrospective cohort study, using data from 185 patients, operated for gangrenous appendicitis during the period between from January 2023 to February, 2024. Total patients were categorized into two groups based on the wound closure technique employed, immediate wound closure (IWC, n=105) and delayed wound closure (DWC, n=80). Specific dependent variables were the overall SSI rate, days to wound healing and days of hospitalization. Secondary endpoints included a return of symptoms and overall postoperative morbidity. Results: The study also revealed that the incidence of SSIs was relatively low in the DWC group at 8. 0% compared to the (22.0± 0.01) % in the IWC group, which was statistically significant (p<0. 001). The overall IWC time was significantly shorter in the IWC group (11 days) as compared to the DWC group (15 days) (P value = 0. 02). In our study, the DWC group was found to have a lower median LOS of 6 days as compared to IWC group that had a LOS of 8 days. When compared the two groups regarding readmission rates, the difference was not statistically significant (p-value = 0. 05). Conclusion: These delayed wound closure strategies in appendectomy for gangrenous appendicitis are a safe means of decreasing SSIs and hospital stay without a predisposing effect on wound healing and readmission. Based on these findings, it is recommended that DWC is the better approach in the management of such high-risk surgical patients.

show abstract

Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon

Cited by 3 publications

References 67 publications

The impact of an anesthesia residency teaching service on anesthesia-controlled time and postsurgical patient outcomes: a retrospective observational study on 15,084 surgical cases

The impact of an anesthesia residency teaching service on anesthesia-controlled time and postsurgical patient outcomes: a retrospective observational study on 15,084 surgical cases

Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme

Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis

Contact Info

Product

Resources

About