Impact of Resident Involvement in Surgery (IRIS-NSQIP): Looking at the Bigger Picture Based on the American College of Surgeons-NSQIP Database

Saliba, Antoine N.; Taher, Alì; Tamim, Hani; Harb, Afif; Mailhac, Aurélie; Radwan, Amr; Jamali, Faek R.

doi:10.1016/j.jamcollsurg.2015.10.011

Cited by 58 publications

(20 citation statements)

References 39 publications

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“…As procedural volume for TKA continues to rise, attendings may be more inclined to allow trainees to assist in arthroplasty procedures. Previous studies have shown a high proportion of resident involvement in cases in NSQIP [10,28], and therefore, a rise in operative time across the included years may be expected. However, this was not the case.…”

Section: Discussionmentioning

confidence: 99%

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

Acuña

Samuel

Karnuta

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

Acuña

Samuel

Karnuta

et al. 2020

The Journal of Arthroplasty

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“…From a clinical perspective, our policy is that every surgical procedure has to be at least assisted by a board-certified surgeon and that steps of every operation have to be assisted whenever possible. Data from various analysis of the American NSQIP database show that outcomes are not influenced by resident involvement [ 24 ]. Moreover, every patient requires presentation in a multidisciplinary tumor board.…”

Section: Discussionmentioning

confidence: 99%

Patient Blood Management improves outcome in oncologic surgery

et al. 2018

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BackgroundPatient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS).MethodsRetrospective analysis of patients 2 years before and after PBM implementation. The primary endpoint was OS at 2 years after surgery. We identified a sample size of 824 to detect a 10% improvement in survival in the PBM group.ResultsThe analysis comprised of 836 patients that underwent oncologic surgery, 389 before and 447 after PBM, was implemented. Patients in the PBM+ presented significantly more frequent with normal hemoglobin values before surgery than PBM− (56.6 vs. 35.7%; p < 0.001). The number of transfusions was significantly reduced from 5.5 ± 11.1 to 3.0 ± 6.9 units/patient (p < 0.001); moreover, the percentage of patients being transfused during the clinic stay was significantly reduced from 62.4 to 40.9% (p < 0.001). Two-year OS was significantly better in the PBM+ and increased from 67.0 to 80.1% (p = 0.001). A normal hemoglobin value (> 12 g/dl in female and > 13 g/dl in male) before surgery (HR 0.43, 95% CI 0.29–0.65, p < 0.001) was the only independent predictive factor positively affecting survival.ConclusionsPBM is a quality improvement tool that is associated with better mid-term surgical oncologic outcome. The root cause for improvement is the increase of patients entering surgery with normal hemoglobin values.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1456-9) contains supplementary material, which is available to authorized users.

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“…17 This potential risk is balanced by studies suggesting that, in general, patients do not have worse outcomes if residents are involved in their surgical procedure. 18 The unique responsibilities and contributions of teaching hospitals should be recognized by funding bodies and activitybased funding should account for the increased operative time associated with training the next generation of medical professionals.…”

Section: Discussionmentioning

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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Impact of Resident Involvement in Surgery (IRIS-NSQIP): Looking at the Bigger Picture Based on the American College of Surgeons-NSQIP Database

Abstract: Our study confirms that, across different surgical subspecialties, resident involvement in surgery is associated with comparable morbidity and lower mortality outcomes. This provides a reassuring answer to patients, attending surgeons, and surgical program directors.

Cited by 58 publications

References 39 publications

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

Patient Blood Management improves outcome in oncologic surgery

The impact of teaching on the duration of common urological operations

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