Assessing Trainee Impact on Operative Time for Common General Surgical Procedures in ACS-NSQIP

Papandria, Dominic; Rhee, Daniel S.; Ortega, Gezzer; Zhang, Yiyi; Gorgy, Amany; Makary, Martin A.; Abdullah, Fizan

doi:10.1016/j.jsurg.2011.08.003

Cited by 156 publications

(92 citation statements)

References 29 publications

(23 reference statements)

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“…Trainee involvement in a surgical procedure has been shown in previous studies to lengthen surgical time and hospital stay with conflicting results when including the resident postgraduate year (PGY) level in the analyses [4][5][6]. The present work demonstrates a linear correlation between resident PGY level and morbidity rate.…”

mentioning

confidence: 51%

The Trainee Effect on Early Postoperative Surgical Outcomes: Reflects the Effect of Resident Involvement or Hospital Capacity to Overcome Complications?

Can

2017

Journal of Investigative Surgery

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confidence: 51%

The Trainee Effect on Early Postoperative Surgical Outcomes: Reflects the Effect of Resident Involvement or Hospital Capacity to Overcome Complications?

Can

2017

Journal of Investigative Surgery

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“…5 Among basic general surgery procedures (laparoscopic cholecystectomy or appendectomy, or open inguinal hernia repair, all of which tended to take approximately an hour), skin-to-skin operative time increased by 12-20 minutes with the involvement of both junior or senior residents, compared to the attending surgeon operating alone. 7 It is essential for academic urologists and anesthesiologist to continue to balance the priorities of resident education and hands-on learning opportunities with the efficient and responsible use of publicly funded healthcare resources, such as operating room time. In addition to resource implications, previous studies have demonstrated an increased risk in complications, such as surgical site infections, among certain surgical procedures when they are significantly prolonged.…”

Section: Discussionmentioning

confidence: 99%

“…While non-teaching-based hospitals exist primarily to deliver patient care, academic hospitals have the additional demands of clinical research and the training and education of medical and nursing students, allied health professionals, and postgraduate physicians (interns, residents, and fellows). The inclusion of medical residents in surgical procedures performed in the U.S. has been shown to increase the risk of a prolonged operation for specific urological procedures (such as laparoscopic urological oncology procedures 4 and transurethral surgery 5 ), as well as in other surgical specialities (such as gynecology 6 and general surgery 7 ). The increase in operative duration associated with training future medical professionals inherently increases the operating room cost of procedures at academic hospitals and is not currently accounted for in many activity-based funding models.…”

Section: Introductionmentioning

confidence: 99%

The impact of teaching on the duration of common urological operations

Welk

Winick-Ng

McClure

et al. 2016

CUAJ

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Introduction: The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals. Methods: We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume. Results: 114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10-21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres. Conclusions: Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.

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“…6 LA is a safe procedure for junior trainees to perform; [7][8][9] however resident involvement in LA has resulted in increased operative time and complications. 10,11 The overall rate of major complications following a laparoscopic procedure is about 1.4 per 1000 procedures. 12 However, the incidence of port site complications following laparoscopic surgery is around 21 per 100 000 cases.…”

Section: Introductionmentioning

confidence: 99%

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

Nason

Baig²,

Burke

et al. 2015

CUAJ

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55case series AbstractIntroduction: Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. Methods: A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012-2013. Iatrogenic visceral injuries were identified and operative notes examined. Results: During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically. Conclusion: Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication. IntroductionAppendicectomy is the most common emergency surgical procedure performed worldwide.1 Laparoscopy plays a valuable role in the management of patients with acute lower abdominal pain. A Cochrane review has recommended laparoscopy and laparoscopic appendicectomy (LA) in patients with suspected appendicitis unless laparoscopy itself is contraindicated or not feasible.2 Minimally-invasive approaches have revolutionized surgery.3 Laparoscopic surgery has well-documented benefits with associated shorter length of stay, quicker return of bowel function, decreased analgesic requirements, lower rates of wound complications, and improved cosmesis.4,5 Furthermore LA is seen as an excellent training opportunity and evidence shows an attainable learning curve.6 LA is a safe procedure for junior trainees to perform; 7-9 however resident involvement in LA has resulted in increased operative time and complications. 10,11The overall rate of major complications following a laparoscopic procedure is about 1.4 per 1000 procedures. 12However, the incidence of port site complications following laparoscopic surgery is around 21 per 100 000 cases.13 Port site complications can be grouped into access-related complications (vascular or visceral injuries) 14 and postoperative complications (wound infection or port site herniation). 15,16Currently, there is little data regarding iatrogenic secondary trocar induced injuries in LA. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. MethodsWe performed a retrospective analysis of LA over a 2-year period (2012)(2013) at a tertiary referral university teaching hospital. Data were obtained from the hospital in-patient enquiry (HIPE) system. The outcomes measured included the incidence of iatrogenic bladder injuries at the time of LA, mode and time of clinical presentation, type of port used, le...

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Assessing Trainee Impact on Operative Time for Common General Surgical Procedures in ACS-NSQIP

Cited by 156 publications

References 29 publications

The Trainee Effect on Early Postoperative Surgical Outcomes: Reflects the Effect of Resident Involvement or Hospital Capacity to Overcome Complications?

The Trainee Effect on Early Postoperative Surgical Outcomes: Reflects the Effect of Resident Involvement or Hospital Capacity to Overcome Complications?

The impact of teaching on the duration of common urological operations

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

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