Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity

Kasten, Kevin R.; Celio, Adam C.; Trakimas, Lauren E.; Manwaring, Mark L.; Spaniolas, Konstantinos

doi:10.1007/s00464-017-5726-3

Cited by 8 publications

(3 citation statements)

References 54 publications

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“…Trainee participation has been associated with adverse outcomes in other specialties. In elective surgical practice, the association between trainee performance and adverse outcome is less convincing; although the procedure took longer if trainees operated (for example laparoscopic cholecystectomy and open inguinal hernia), several studies reported no increase in mortality.…”

Section: Introductionmentioning

confidence: 99%

Trainee-led emergency laparotomy operating

Boyd-Carson

Doleman

Lockwood

et al. 2020

British Journal of Surgery

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Background To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at emergency laparotomy. The aim of this study was to describe the patterns of trainee‐led emergency laparotomy operating and the association between postoperative outcomes. Methods Data on all patients who had an emergency laparotomy between December 2013 and November 2017 were extracted from the National Emergency Laparotomy Audit database. Patients were grouped by grade of operating surgeon: trainee (specialty registrar) or consultant (including post‐Certificate of Completion of Training fellows). Trends in trainee operating by deanery, hospital size and time of day of surgery were investigated. Univariable and adjusted regression analyses were performed for the outcomes 90‐day mortality and return to theatre, with analysis of patients in operative subgroups segmental colectomy, Hartmann's procedure, adhesiolysis and repair of perforated peptic ulcer disease. Results The study cohort included 87 367 patients. The 90‐day mortality rate was 15·1 per cent in the consultant group compared with 11·0 per cent in the trainee group. There were no increased odds of death by 90 days or of return to theatre across any of the operative groups when the operation was performed with a trainee listed as the most senior surgeon in theatre. Trainees were more likely to operate independently in high‐volume centres (highest‐ versus lowest‐volume centres: odds ratio (OR) 2·11, 95 per cent c.i. 1·91 to 2·33) and at night (00.00 to 07.59 versus 08.00 to 11.59 hours; OR 3·20, 2·95 to 3·48). Conclusion There is significant variation in trainee‐led operating in emergency laparotomy by geographical area, hospital size and by time of day. However, this does not appear to influence mortality or return to theatre.

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Section: Introductionmentioning

confidence: 99%

Trainee-led emergency laparotomy operating

Boyd-Carson

Doleman

Lockwood

et al. 2020

British Journal of Surgery

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“…Studies have suggested that trainee involvement can result in improved colonic cancer detection rates at endoscopy 5 , lower bleeding complication rates in endocrine surgery 6 , and lower morbidity levels at teaching hospitals compared with non-teaching hospitals 7 . A recent study 9 has suggested that the grade of trainee may be an important factor, with senior trainee involvement associated with poorer outcomes. A recent study 9 has suggested that the grade of trainee may be an important factor, with senior trainee involvement associated with poorer outcomes.…”

Section: Introductionmentioning

confidence: 99%

Trainee performance in radical gastrectomy and its effect on outcomes

et al. 2020

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Background: This study aimed to determine whether trainee involvement in D2 gastrectomies was associated with adverse outcomes. Methods: Data from a prospectively created database of consecutive patients undergoing open D2 total (TG) or subtotal (STG) gastrectomy with curative intent between January 2009 and January 2014 were reviewed. Short-and long-term clinical outcomes were compared in patients operated on by consultants and those treated by trainees under consultant supervision. Results: A total of 272 D2 open gastrectomies were performed, 123 (45⋅2 per cent) by trainees. There was no significant difference between consultants and trainees in median duration of surgery (TG: 240 (range 102-505) versus 240 (170-375) min respectively, P = 0⋅452; STG: 225 (150-580) versus 212 (125-380) min, P = 0⋅192), number of resected nodes (TG: 30 (13-101) versus 30 (11-102), P = 0⋅681; STG: 26 (5-103) versus 25 (1-63), P = 0⋅171), length of hospital stay (TG: 15 (7-78) versus 15 (8-65) days, P = 0⋅981; STG: 10 (6-197) versus 14 (7-85) days, P = 0⋅242), overall morbidity (TG: 44 versus 49 per cent, P = 0⋅314; STG: 34 versus 25 per cent, P = 0⋅113) or mortality (TG: 4 versus 2 per cent; P = 0⋅293). No difference in predicted 5-year overall survival was noted between the two cohorts (TG: 68 per cent for consultants versus 77 per cent for trainees, P = 0⋅254; STG: 70 versus 75 per cent respectively, P = 0⋅512). The trainee cohort had lower median blood loss for both TG (360 (range 90-1200) ml versus 600 (70-2350) ml for consultants; P = 0⋅042) and STG (235 (50-1000) versus 360 (50-3000) ml respectively; P = 0⋅053). Conclusion: Clinical outcomes were not compromised by supervised trainee involvement in D2 open gastrectomy.

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“…Lens contamination events may be avoided by a skilled scope operator. Recently, as the development of laparoscopic surgery makes laparoscopic colorectal cancer surgery more prevalent in mid-sized municipal hospitals in Japan, young trainees have increasing opportunities to attend laparoscopic colorectomy procedures as a scope operator [7].…”

Section: Introductionmentioning

confidence: 99%

Reduction in the Frequency of Scope Contamination During Laparoscopic Surgery Correlates with Scope Operator Experience

Ito

Minamimura

Tanaka

et al. 2020

Preprint

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Background As laparoscopic colorectal cancer surgery becomes more common in mid-sized municipal hospitals in Japan, young trainees have increasing opportunities to attend laparoscopic colorectomy procedures as a scope operator. However, the performance of the inexperienced scope operator may affect the operative outcome. This study aims to provide a quantitative measure of the scope operator’s performance, by analyzing scope contamination events, and to determine the influence of this measure on surgical outcomes.Methods We retrospectively analyzed the operative videos of 70 sigmoid colectomy or high anterior resection cases performed between February 2014 and July 2019 in our hospital. Twenty-four young surgeons alternated assisting with the procedure as the scope operator. To quantify the scope operators’ performance, the frequency of laparoscopic lens contamination events (FLC) during surgery was determined. The FLC and operative outcomes were compared among the first, second, and subsequent procedures performed by each scope operator. We identified the cause of lens contamination and surgical situation in which contamination occurred. We examined the relationship between the FLC and experience level of the scope operator for specific types of contamination and surgical situations.Results A total of 733 lens contaminations were observed. The median FLC was 10 (minimum: 1, maximum: 34) during each operation. The FLC and number of procedures performed by the scope operator had a negative linear correlation. Multivariate analysis showed that the experience level of the scope operator was the only independent predictor of operation time. There was also a negative linear correlation between the number of procedures performed by the scope operator and scope contamination during colorectal mobilization.Conclusions Scope operator experience decreases scope contamination and could facilitate the laparoscopic surgical workflow. The influence of the scope operator’s performance should be emphasized.

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Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity

Cited by 8 publications

References 54 publications

Trainee-led emergency laparotomy operating

Trainee-led emergency laparotomy operating

Trainee performance in radical gastrectomy and its effect on outcomes

Reduction in the Frequency of Scope Contamination During Laparoscopic Surgery Correlates with Scope Operator Experience

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