The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections

Abstract

Background Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined. Methods We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006 and 2012 using the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models were constructed to determine any association between resident participation and surgical outcomes. Results Pancreatic resections (n = 16,045; 62.9%) were more common than liver resections (n = 9,466; 37%). Residents participated in the majority of cases (n = 21,857; 86%), with most involvement at the senior level (postgraduate year ≥ 3, n = 21,147; 97%). Resident participation resulted in slightly longer mean operative times (hepatic, 9 minutes; pancreatic, 22 minutes; both P < .01). Need for perioperative transfusion, hospital duration of stay, and reoperation rates were unaffected by resident participation (all P > .05). Resident participation resulted in a higher risk of overall morbidity (odds ratio [OR], 1.14; 95% CI, 1.05–1.24; P = .001), but not major morbidity (OR, 1.05; 95% CI, 0.93–1.20; P = .40) after liver and pancreas resection. Resident participation resulted in lower odds of 30-day mortality after liver and pancreas resections (OR, 0.75; 95% CI, 0.60–0.94; P = .01). Conclusion Although resident participation resulted in slightly longer operative times and a modest increase in overall complications after liver and pancreatic resection, other metrics such as duration of stay, major morbidity, and mortality were unaffected. These data have important implications for educating patients regarding resident participation in these complex cases.

Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi‐institutional analysis

“…24 Despite improvements in mortality, the morbidity associated with hepatic resection remains in the range of 30-40%. 24,25 In particular, the morbidity and mortality following liver resection combined with vascular resection can be considerably higher than a routine hepatectomy. For example, de Jong et al recently reported on the impact of PV resection on perioperative outcomes in 305 patients who underwent resection for hilar cholangiocarcinoma.…”

“…Perioperative and technical advances have dramatically reduced the risks associated with hepatic resection such that most centers report a mortality of less than 2‐3% for liver surgery . Despite improvements in mortality, the morbidity associated with hepatic resection remains in the range of 30‐40% . In particular, the morbidity and mortality following liver resection combined with vascular resection can be considerably higher than a routine hepatectomy.…”

Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons

“…In that study, the resident's role was that of a first assistant [5]. Studies that investigate the topic of education by analyzing the NSQIP database usually give no further information about the role of the resident [12].…”

Training in hepato‐pancreato‐biliary surgery during residency: past, present and future perspectives

“…In this regard, recent evidence has shown that resident participation as operating surgeons in surgical procedures of varying complexity, may be considered ethical, safe, and responsible whenever implemented in the framework of a residencytraining program with continuous supervision and national accreditation [7]. Moreover, recent results from the ACS NSQIP database found that although both liver and pancreas resections with resident participants resulted in a longer operative time, other parameters such as duration of stay and perioperative major morbidity were unaffected [17]. Sachs et al [18] characterized and quantified the procedural volumes of complex HPB procedures among graduating chief residents, concluding that half performed fewer than 10 cases in each of the liver, pancreas, or biliary categories.…”