Is resident assistance equivalent to fellows during hepatectomy?
Objective Hepatectomy is a complex operative procedure frequently performed at academic institutions with trainee participation. The aim of this study was to determine the effect of assistant’s training level on outcomes following hepatectomy. Methods A retrospective review of a prospective, single-...
Saved in:
Published in | Surgical endoscopy Vol. 35; no. 1; pp. 260 - 269 |
---|---|
Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
2021
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Objective
Hepatectomy is a complex operative procedure frequently performed at academic institutions with trainee participation. The aim of this study was to determine the effect of assistant’s training level on outcomes following hepatectomy.
Methods
A retrospective review of a prospective, single-institution ACS-NSQIP database was performed for patients that underwent hepatectomy (2013–2016). Patients were divided by trainee assistant level: hepatopancreatobiliary (HPB) fellow versus general surgery resident (PGY 4–5). Demographic, perioperative, and 30-day outcome variables were compared using Chi-Square/Fisher’s exact, Mann–Whitney
U
test, and multivariable regression. Cases involving a senior-level general surgery resident or HPB fellow as first assistant were included (
n
= 352). Those with a second attending, junior-level resident, or no documented assistant were excluded (
n
= 39).
Results
Patients undergoing hepatectomy with an HPB fellow as primary assistant had more frequent preoperative biliary stenting, longer operative time, and more concomitant procedures including biliary reconstruction, resulting in a higher rate of post-hepatectomy liver failure (PHLF) (15% vs. 8%,
P
= 0.044). However, trainee level did not impact PHLF on multivariable analysis (OR 0.60, 95% CI [0.29–1.25],
P
= 0.173). Fellows assisted with proportionally more major hepatectomies (45% vs. 31%;
P
= 0.010) and resections for hepatobiliary cancers (31% vs. 19%,
P
= 0.014). On stratified analysis of major and minor hepatectomies, outcomes were similar between trainee groups.
Conclusion
Fellows performed higher complexity cases with longer operative time. Despite these differences, outcomes were similar regardless of assistant training level. Resident and HPB fellow participation in operations requiring liver resection provide comparable quality of care. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0930-2794 1432-2218 |
DOI: | 10.1007/s00464-020-07388-9 |