First assistant impact on early morbidity and mortality in bariatric surgery

Mahan, Mark E.; Parker, David M.; Fluck, Marcus; Gabrielsen, Jon; Petrick, Anthony; Horsley, Ryan

doi:10.1016/j.soard.2019.06.025

Cited by 16 publications

(6 citation statements)

References 12 publications

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“…Prior ndings in urological surgical education demonstrated that resident involvement universally increases operative time in open, laparoscopic, and robotic surgeries [12][13][14][15][16] . Studies from general surgery demonstrated similar ndings when comparing resident directly to non-trainee rst assist (PA/RN) 9,10 . Our study showed that operative time was noted to be slightly increased (71.4 min vs 87.9 min, p < 0.01) with resident compared with RNFA in IPP surgeries.…”

Section: Discussionmentioning

confidence: 85%

“…This exposure must also be measured against surgical goals of e ciency, satisfactory outcomes, and low rates complications. Dedicated RNFAs are often utilized in many surgical procedures when residents or MD-surgeon support is not readily accessible [9][10][11] , however the there were no prior reports on how different assistants might affect the outcomes of IPP surgeries. Our study evaluates these metrics in a novel fashion by comparing IPP cases performed with residents and RNFA.…”

Section: Discussionmentioning

confidence: 99%

“…Another study reported that resident involvement in TURBT is associated with increased odds of 30-day readmission regardless of PGY level, but not with the overall complication and reoperation rate 19 . Studies in general surgery education that directly compared outcomes with trainee involvement to that of non-trainee rst assist (PA/RN) have also shown increased readmission or ICU admission rates in specialized procedures 9,10 .…”

Section: Discussionmentioning

confidence: 99%

“…The limited prosthetic exposure of residency raises the question if utilizing dedicated registered nurse rst assistants (RNFA) would in uence the surgical outcomes differently. Reports by non-urological specialties nd mortality rates in a variety of surgical procedures to be independent of types of rst assistant, but certain adverse events are associated with resident involvement in specialized procedures [9][10][11] . Given the limited reports on how assistants may in uence the outcomes of IPP surgeries, we report a single-surgeon case series comparing the surgical outcomes of IPP surgery performed with the assistance of RNFA versus residents.…”

Section: Introductionmentioning

confidence: 99%

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212 New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

Wu¹,

Swanton²,

Gross³

2022

The Journal of Sexual Medicine

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Introduction Inflatable penile prosthesis (IPP) placement is a critical component of urology residency education. Resident trainees are useful in IPP cases, but resident assistance is not always available to prosthetic urologists. Registered Nurse First Assistants (RNFAs) can also serve as capable assistants during IPP procedures. We reviewed our data to compare intraoperative and postoperative complications in IPP cases with residents or RNFAs as assistants. We also compared the differences in the surgical procedures with either type of assistant. Objective Comparing the influence of different assistants on perioperative complications of Inflatable Penile Prosthesis Methods Medical records of patients who underwent IPP placement by a single surgeon between 2017 and 2020 were retrospectively reviewed with IRB approval. Baseline patient characteristics, details of surgical procedure, and outcomes were collected. A logistic regression model was used to identify predictors of complications. Student's T test was used to examine for differences in total OR time between different assistants. Results A total of 210 patients who underwent IPP surgery were identified, among which 168 (80%) placements were assisted by RNFAs, and 42 (20%) by urology residents. Complications were reported in 37 (17.6%) patients. Clavien-Dindo complications were grades V (1%, n=2), IIIb (11%, n=23), II (0.5%, n=1), and I (7%, n=14). There was no significant difference in the rate of complications for IPP placement assisted by a resident or RNFA (OR 0.95, CI 0.35 – 2.31) but this was limited by the overall power in assessing complications. Resident-assisted IPP placements were found to be associated with longer operative time than those assisted by RNFAs (86.2 ± 23.1 min vs 72.9 ± 35.5 min, p<0.01). Patient factors including new IPP, BMI>30, DM, and positive urine culture were also not associated with increased complication rate. Current smokers were noted to have more complications (OR 2.51, CI 0.94 – 6.30), although this was not statistically significant. Patients were followed for 12.2 ± 10.8 months postoperatively. Conclusions Resident-assisted IPP placement with a high-volume surgeon is not associated with observable increase rate of complications comparing to those assisted by RNFAs. Moreover, resident involvement is only associated with slight increase in operative time compared to RNFA-assisted IPP placement. Overall complications were low in this series. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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212 New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

Wu¹,

Swanton²,

Gross³

2022

The Journal of Sexual Medicine

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“…Second, the surgeon should be teamed with an experienced assistant. Previous research has shown that less experienced first assistants in RYGB and SG surgery increase the 30-day readmission rate and the need for intensive care unit management [ 20 ]. Third, with today’s advancement in technology, a great deal of research has focused on the benefits of simulator training [ 21 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

The influence of summer closure on serious postoperative complications in bariatric surgery

Fall

Sundbom

Stenberg

2022

Langenbecks Arch Surg

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Introduction Bariatric surgery is an effective method of treating obesity, with gastric bypass and sleeve gastrectomy being the most common techniques used worldwide. Despite the technical challenges in these methods, little is known about the effects of summer closure on the incidence of serious postoperative complications in surgeries performed shortly after summer vacation. This has therefore been studied in our large cohort. Materials and methods A retrospective cohort study based on data from the Scandinavian Obesity Surgery Registry was conducted. Patients who underwent a primary gastric bypass or sleeve gastrectomy operation between 2010 and 2019 were included. The rate of serious complications within 30 days after surgery for patients who underwent surgery the first month after summer closure was compared to those who underwent surgery during the rest of the year using the χ2 test and adjusted logistic regression. Results The study included 42,404 patients, 36,094 of whom underwent gastric bypass and 6310 of whom received sleeve gastrectomy. Summer closure was associated with an increased risk for serious postoperative complications in gastric bypass surgery (adjusted odds ratio (adj-OR) = 1.17; 95% confidence interval (CI): 1.01–1.36). No statistically significant association was seen for sleeve gastrectomy (adj-OR = 1.17; 95% CI: 0.72–1.91), nor in overall complication rate. Conclusions Summer closure increases the risk of serious postoperative complications in gastric bypass surgery. No statistically significant association was found for sleeve gastrectomy surgery.

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Complications and Readmissions Associated with First Assistant Training Level Following Elective Bariatric Surgery

Yuce

Holmstrom

Soper

et al. 2021

Journal of Gastrointestinal Surgery

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First assistant impact on early morbidity and mortality in bariatric surgery

Cited by 16 publications

References 12 publications

212 New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

212 New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

The influence of summer closure on serious postoperative complications in bariatric surgery

Complications and Readmissions Associated with First Assistant Training Level Following Elective Bariatric Surgery

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