BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training. METHODS: We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities. RESULTS: Of the 18,333 LRYGB performed, 4,349 (24%) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7, p < 0.001) and fewer comorbidities. Mortality was 0.2 and 0.1% and overall morbidity was 4.8 and 6.0% for attending and fellow groups, respectively. On adjusted analysis, mortality was similar, but fellow cases had 30% more morbidity (p = 0.001). Specifically, fellows increased the odds of superficial surgical site infections (SSSIs) [odds ratio (OR) = 1.4, p = 0.01], urinary infections (UTIs) (OR = 1.7, p = 0.002), and sepsis (OR = 1.5, p = 0.05). During the first 6 months, fellows increased the odds of DVT (OR = 4.7, p = 0.01), SSIs (OR = 1.5, p = 0.001), UTIs (OR = 1.8, p = 0.004), and sepsis (OR = 1.9, p = 0.008). By the second half of training, fellow cases demonstrated outcomes equivalent to attending cases. CONCLUSIONS: Involving fellows in LRYGB may increase DVT, SSIs, UTIs, and sepsis, especially early in training. By completion of their training, cases involving fellows exhibited outcomes similar to cases without trainees. This supports both the need for fellowship training in bariatric surgery and the success of training to optimize patient outcomes.
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training. METHODS: We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities. RESULTS: Of the 18,333 LRYGB performed, 4,349 (24%) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7, p < 0.001) and fewer comorbidities. Mortality was 0.2 and 0.1% and overall morbidity was 4.8 and 6.0% for attending and fellow groups, respectively. On adjusted analysis, mortality was similar, but fellow cases had 30% more morbidity (p = 0.001). Specifically, fellows increased the odds of superficial surgical site infections (SSSIs) [odds ratio (OR) = 1.4, p = 0.01], urinary infections (UTIs) (OR = 1.7, p = 0.002), and sepsis (OR = 1.5, p = 0.05). During the first 6 months, fellows increased the odds of DVT (OR = 4.7, p = 0.01), SSIs (OR = 1.5, p = 0.001), UTIs (OR = 1.8, p = 0.004), and sepsis (OR = 1.9, p = 0.008). By the second half of training, fellow cases demonstrated outcomes equivalent to attending cases. CONCLUSIONS: Involving fellows in LRYGB may increase DVT, SSIs, UTIs, and sepsis, especially early in training. By completion of their training, cases involving fellows exhibited outcomes similar to cases without trainees. This supports both the need for fellowship training in bariatric surgery and the success of training to optimize patient outcomes.
Authors: Mohamed R Ali; David S Tichansky; Shanu N Kothari; Corrigan L McBride; Adolfo Z Fernandez; Harvey J Sugerman; John M Kellum; Luke G Wolfe; Eric J DeMaria Journal: Surg Endosc Date: 2009-06-11 Impact factor: 4.584
Authors: Timothy D Jackson; Jeffrey J Wannares; R Todd Lancaster; David W Rattner; Matthew M Hutter Journal: Surg Endosc Date: 2011-02-07 Impact factor: 4.584
Authors: Yuliya Y Yurko; Mark W Scerbo; Ajita S Prabhu; Christina E Acker; Dimitrios Stefanidis Journal: Simul Healthc Date: 2010-10 Impact factor: 1.929
Authors: R Grant Highstead; Laura S Johnson; Laura C Johnson; James H Street; Christine T Trankiem; Susan O Kennedy; Jack A Sava Journal: J Trauma Date: 2009-11
Authors: Kenji Inaba; Gustavo Recinos; Pedro G R Teixeira; Galinos Barmparas; Peep Talving; Ali Salim; Carlos Brown; Peter Rhee; Demetrios Demetriades Journal: J Trauma Date: 2010-01
Authors: Pamela S Kim; Dana A Telem; Maria S Altieri; Mark Talamini; Jie Yang; Qiao Zhang; Aurora D Pryor Journal: J Gastrointest Surg Date: 2015-02-10 Impact factor: 3.452
Authors: Donald K Groves; Maria S Altieri; Brianne Sullivan; Jie Yang; Mark A Talamini; Aurora D Pryor Journal: J Gastrointest Surg Date: 2018-07-06 Impact factor: 3.452
Authors: Robert W Krell; Nancy J O Birkmeyer; Bradley N Reames; Arthur M Carlin; John D Birkmeyer; Jonathan F Finks Journal: J Am Coll Surg Date: 2013-10-29 Impact factor: 6.113
Authors: Kevin R Kasten; Adam C Celio; Lauren Trakimas; Mark L Manwaring; Konstantinos Spaniolas Journal: Surg Endosc Date: 2017-07-19 Impact factor: 4.584
Authors: Ali Aminian; Rizwan M Chaudhry; Zhamak Khorgami; Amin Andalib; Toms Augustin; John Rodriguez; Matthew Kroh; Philip R Schauer; Stacy A Brethauer Journal: Obes Surg Date: 2016-09 Impact factor: 4.129
Authors: Tarik K Yuce; Amy Holmstrom; Nathaniel J Soper; Alexander P Nagle; Eric S Hungness; Ryan P Merkow; Ezra N Teitelbaum Journal: J Gastrointest Surg Date: 2020-09-15 Impact factor: 3.267
Authors: Gabrielle H van Ramshorst; Mirjam A Kaijser; Jean-Pierre E N Pierie; Bart A van Wagensveld Journal: Obes Surg Date: 2017-11 Impact factor: 4.129