Pritam Singh1, E Jane H Turner2, Julie Cornish3, Aneel Bhangu4. 1. West Midlands Research Collaborative, Birmingham, UK. 2. London Surgical Research Group, Birmingham, UK. 3. Welsh Barber Surgeons Research Group, Birmingham, UK. 4. West Midlands Research Collaborative, Birmingham, UK. Electronic address: aneelbhangu@doctors.org.uk.
Abstract
BACKGROUND: Resident surgeons have been identified as a risk factor for worse outcome after appendectomy. The context of grade of resident and impact of supervision require further investigation. The objective of this study was to determine whether grade and supervision level of resident-performed appendectomy affects patient outcome. METHODS: A multicenter, prospective cohort study was performed for consecutive patients undergoing appendectomy during May and June 2013. The primary endpoint for this analysis was the 30-day adverse event rate. Supervision was defined as resident-performed appendectomy with an attending scrubbed. Multivariable binary logistic regression was used to take into account case mix and produce adjusted odds ratios (OR). RESULTS: From 2,867 appendectomies, 87% were performed by residents, and 72% were performed unsupervised. Residents operated on significantly younger patients with lower American Society of Anesthesiologists scores. Although wound infection rates were similar between attendings, and senior and junior residents (4.1%, 3.8%, 3.4% respectively; P = .486), pelvic abscess rate was greater for attendings (5.2%, 2.7%, 2.4%; P = .045). In adjusted models, supervised senior, supervised junior, and unsupervised junior residents showed no difference in 30-day adverse event rates compared with attendings (OR, 1.07 [P = .834], 0.93 [P = .773], and 0.83 [P = .264] respectively); unsupervised senior residents had a lesser rate of adverse events (OR, 0.71; P = .045). All resident groups showed no difference for rates of histopathologically normal appendectomy compared with attendings. CONCLUSION: Resident-performed appendectomy does not worsen patient outcomes. These findings support independent resident operating rights for selected cases. The system relies on mutual credentialing of competency between residents and supervising attendings.
BACKGROUND: Resident surgeons have been identified as a risk factor for worse outcome after appendectomy. The context of grade of resident and impact of supervision require further investigation. The objective of this study was to determine whether grade and supervision level of resident-performed appendectomy affects patient outcome. METHODS: A multicenter, prospective cohort study was performed for consecutive patients undergoing appendectomy during May and June 2013. The primary endpoint for this analysis was the 30-day adverse event rate. Supervision was defined as resident-performed appendectomy with an attending scrubbed. Multivariable binary logistic regression was used to take into account case mix and produce adjusted odds ratios (OR). RESULTS: From 2,867 appendectomies, 87% were performed by residents, and 72% were performed unsupervised. Residents operated on significantly younger patients with lower American Society of Anesthesiologists scores. Although wound infection rates were similar between attendings, and senior and junior residents (4.1%, 3.8%, 3.4% respectively; P = .486), pelvic abscess rate was greater for attendings (5.2%, 2.7%, 2.4%; P = .045). In adjusted models, supervised senior, supervised junior, and unsupervised junior residents showed no difference in 30-day adverse event rates compared with attendings (OR, 1.07 [P = .834], 0.93 [P = .773], and 0.83 [P = .264] respectively); unsupervised senior residents had a lesser rate of adverse events (OR, 0.71; P = .045). All resident groups showed no difference for rates of histopathologically normal appendectomy compared with attendings. CONCLUSION: Resident-performed appendectomy does not worsen patient outcomes. These findings support independent resident operating rights for selected cases. The system relies on mutual credentialing of competency between residents and supervising attendings.
Authors: Rosalie A Carr; Catherine W Chung; Christian M Schmidt; Andrea Jester; Molly E Kilbane; Michael G House; Nicholas J Zyromski; Attila Nakeeb; C Max Schmidt; Eugene P Ceppa Journal: J Gastrointest Surg Date: 2017-02-13 Impact factor: 3.452
Authors: Theophilus T K Anyomih; Thomas Jennings; Alok Mehta; J Robert O'Neill; Ioanna Panagiotopoulou; Stavros Gourgiotis; Elizabeth Tweedle; John Bennett; R Justin Davies; Constantinos Simillis Journal: Pediatr Surg Int Date: 2022-07-20 Impact factor: 2.003
Authors: Fernando J Kim; Rodrigo Donalisio da Silva; Diedra Gustafson; Leticia Nogueira; Timothy Harlin; David L Paul Journal: Patient Saf Surg Date: 2015-06-05
Authors: Salomone Di Saverio; Arianna Birindelli; Micheal D Kelly; Fausto Catena; Dieter G Weber; Massimo Sartelli; Michael Sugrue; Mark De Moya; Carlos Augusto Gomes; Aneel Bhangu; Ferdinando Agresta; Ernest E Moore; Kjetil Soreide; Ewen Griffiths; Steve De Castro; Jeffry Kashuk; Yoram Kluger; Ari Leppaniemi; Luca Ansaloni; Manne Andersson; Federico Coccolini; Raul Coimbra; Kurinchi S Gurusamy; Fabio Cesare Campanile; Walter Biffl; Osvaldo Chiara; Fred Moore; Andrew B Peitzman; Gustavo P Fraga; David Costa; Ronald V Maier; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Roberto Cirocchi; Valeria Tonini; Alice Piccinini; Gregorio Tugnoli; Elio Jovine; Roberto Persiani; Antonio Biondi; Thomas Scalea; Philip Stahel; Rao Ivatury; George Velmahos; Roland Andersson Journal: World J Emerg Surg Date: 2016-07-18 Impact factor: 5.469