Megan Sippey1, Konstantinos Spaniolas1, Mark L Manwaring1, Walter E Pofahl1, Kevin R Kasten2. 1. Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA. 2. Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA. Electronic address: kastenk14@ecu.edu.
Abstract
BACKGROUND: We evaluated effect of resident involvement on outcomes after laparoscopic and open colon resection for malignancy. METHODS: Patients undergoing colectomy were queried using the American College of Surgeons' National Surgical Quality Improvement Program. "Attending alone" and "Resident" cohorts were compared with primary end point of overall morbidity. RESULTS: Of 37,330 patients, residents were involved in 26,190 (70.2%) cases. Attending alone patients were older with higher vascular, cardiac, and pulmonary comorbidity. Univariate analysis demonstrated increased operative time (181.0 ± 98.4 vs 138.7 ± 77.0, P < .001), reoperation (5.7% vs 5.2%, P = .041), and readmission rates (11.9% vs 9.6%, P = .037) with resident involvement. Serious (16.0% vs 13.9%, P < .001), minor (17.5% vs 14.1%, P < .001), and overall morbidity (26.4% vs 22.5%, P < .001) were higher with resident participation. Mortality (2.0% vs 2.8%, P < .001) and failure to rescue (.8% vs 1.2%, P < .029) were lower with resident involvement. Resident involvement showed independent association with overall morbidity in both laparoscopic (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.38, P < .001) and open cases (odds ratio 1.3, 95% confidence interval, 1.18 to 1.35, P < .001). CONCLUSIONS: Resident participation in colectomy for malignancy is associated with lower mortality at the expense of higher overall morbidity.
BACKGROUND: We evaluated effect of resident involvement on outcomes after laparoscopic and open colon resection for malignancy. METHODS:Patients undergoing colectomy were queried using the American College of Surgeons' National Surgical Quality Improvement Program. "Attending alone" and "Resident" cohorts were compared with primary end point of overall morbidity. RESULTS: Of 37,330 patients, residents were involved in 26,190 (70.2%) cases. Attending alone patients were older with higher vascular, cardiac, and pulmonary comorbidity. Univariate analysis demonstrated increased operative time (181.0 ± 98.4 vs 138.7 ± 77.0, P < .001), reoperation (5.7% vs 5.2%, P = .041), and readmission rates (11.9% vs 9.6%, P = .037) with resident involvement. Serious (16.0% vs 13.9%, P < .001), minor (17.5% vs 14.1%, P < .001), and overall morbidity (26.4% vs 22.5%, P < .001) were higher with resident participation. Mortality (2.0% vs 2.8%, P < .001) and failure to rescue (.8% vs 1.2%, P < .029) were lower with resident involvement. Resident involvement showed independent association with overall morbidity in both laparoscopic (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.38, P < .001) and open cases (odds ratio 1.3, 95% confidence interval, 1.18 to 1.35, P < .001). CONCLUSIONS: Resident participation in colectomy for malignancy is associated with lower mortality at the expense of higher overall morbidity.
Authors: Gabriela Batista Rodríguez; Andrea Balla; Santiago Corradetti; Carmen Martinez; Pilar Hernández; Jesús Bollo; Eduard M Targarona Journal: Int J Colorectal Dis Date: 2018-04-06 Impact factor: 2.571
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: 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: Sherif Aly; Susanna W L de Geus; Cullen O Carter; Teviah E Sachs; Donald T Hess; Jennifer F Tseng; Luise I M Pernar Journal: Surg Endosc Date: 2021-03-24 Impact factor: 4.584