Skip to main content
Top
Published in: Surgical Endoscopy 11/2014

01-11-2014

A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair

Authors: Samuel W. Ross, Bindhu Oommen, Mimi Kim, Amanda L. Walters, John M. Green, B. Todd Heniford, Vedra A. Augenstein

Published in: Surgical Endoscopy | Issue 11/2014

Login to get access

Abstract

Introduction

The purpose of this study was to analyze the effect of residents on patient outcomes in laparoscopic ventral hernia repair (LVHR).We hypothesized that increasing postgraduate year (PGY) level would correlate with better outcomes.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2011 for elective LVHR. Attending only cases were used as the control, and resident cases were stratified into junior (PGY 1–3), chief (4–5), and fellow (6+) cases. Standard statistical tests and multivariate regression controlling for age, body mass index, Charlson comorbidity index, smoking, functional status, and inpatient cases were performed for trainee involvement and PGY level.

Results

There were 6,841 ventral hernia repairs that met inclusion criteria: 2,773 attending and 4,068 resident cases. There were 1,644 junior, 1,983 chief, and 441 fellow cases. Patients were similar between the attending and resident groups. The resident group had a higher rate of inpatient cases, general complications, longer operative time, and hospital length of stay. After controlling for confounders in multivariate analysis, only operative time was significantly different; resident cases were 17.7 min longer (CI 15.0–20.6; p < 0.001). There was no significant difference in the rate of wound or major complications, readmission, reoperation, or mortality between attending and resident cases. Demographics were not significantly different between the PGY level strata. On multivariate regression by PGY level with attending alone as the reference, only operative time was significantly different. Juniors (15.7 min, CI 12.2–19.2), chiefs (18.0 min, CI 14.7–21.3), and fellows (24.9 min, CI 19.1–30.7) had significantly longer cases than attending alone; all p < 0.001.

Conclusion

Trainee involvement during LVHR does not change the clinical outcomes for patients as compared to those performed by an attending only. Operative time is significantly longer with increasing PGY level, perhaps indicating the complexity of the operation or increasing trainee involvement as primary surgeon. However, patient care does not suffer, affirming the current surgical training curriculum is appropriate.
Literature
4.
go back to reference Fischer JP, Wes AM, Kovach SJ (2014) The impact of surgical resident participation in breast reduction surgery—outcome analysis from the 2005–2011 ACS-NSQIP datasets. J Plast Surg Hand Surg. doi:10.3109/2000656X.2014.882345 Fischer JP, Wes AM, Kovach SJ (2014) The impact of surgical resident participation in breast reduction surgery—outcome analysis from the 2005–2011 ACS-NSQIP datasets. J Plast Surg Hand Surg. doi:10.​3109/​2000656X.​2014.​882345
5.
go back to reference Kern SQ, Lustik MB, McMann LP, Thibault GP, Sterbis JR (2014) Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program. J Endourol/Endourol Soc 28(1):40–47. doi:10.1089/end.2013.0051 CrossRef Kern SQ, Lustik MB, McMann LP, Thibault GP, Sterbis JR (2014) Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program. J Endourol/Endourol Soc 28(1):40–47. doi:10.​1089/​end.​2013.​0051 CrossRef
7.
go back to reference Iannuzzi JC, Chandra A, Rickles AS, Kumar NG, Kelly KN, Gillespie DL, Monson JR, Fleming FJ (2013) Resident involvement is associated with worse outcomes after major lower extremity amputation. J Vasc Surg 58(3):827–831 e821. doi:10.1016/j.jvs.2013.04.046 Iannuzzi JC, Chandra A, Rickles AS, Kumar NG, Kelly KN, Gillespie DL, Monson JR, Fleming FJ (2013) Resident involvement is associated with worse outcomes after major lower extremity amputation. J Vasc Surg 58(3):827–831 e821. doi:10.​1016/​j.​jvs.​2013.​04.​046
8.
go back to reference Castleberry AW, Clary BM, Migaly J, Worni M, Ferranti JM, Pappas TN, Scarborough JE (2013) Resident education in the era of patient safety: a nationwide analysis of outcomes and complications in resident-assisted oncologic surgery. Ann Surg Oncol 20(12):3715–3724. doi:10.1245/s10434-013-3079-2 PubMedCrossRef Castleberry AW, Clary BM, Migaly J, Worni M, Ferranti JM, Pappas TN, Scarborough JE (2013) Resident education in the era of patient safety: a nationwide analysis of outcomes and complications in resident-assisted oncologic surgery. Ann Surg Oncol 20(12):3715–3724. doi:10.​1245/​s10434-013-3079-2 PubMedCrossRef
9.
go back to reference Schoenfeld AJ, Serrano JA, Waterman BR, Bader JO, Belmont PJ Jr (2013) The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg 133(11):1483–1491. doi:10.1007/s00402-013-1841-3 PubMedCrossRef Schoenfeld AJ, Serrano JA, Waterman BR, Bader JO, Belmont PJ Jr (2013) The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg 133(11):1483–1491. doi:10.​1007/​s00402-013-1841-3 PubMedCrossRef
12.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef
13.
go back to reference Birim O, Maat AP, Kappetein AP, van Meerbeeck JP, Damhuis RA, Bogers AJ (2003) Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer. Eur J Cardio-thorac Surg 23(1):30–34CrossRef Birim O, Maat AP, Kappetein AP, van Meerbeeck JP, Damhuis RA, Bogers AJ (2003) Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer. Eur J Cardio-thorac Surg 23(1):30–34CrossRef
14.
go back to reference Abdollah F, Sun M, Schmitges J, Thuret R, Djahangirian O, Jeldres C, Tian Z, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI (2012) Development and validation of a reference table for prediction of postoperative mortality rate in patients treated with radical cystectomy: a population-based study. Ann Surg Oncol 19(1):309–317. doi:10.1245/s10434-011-1852-7 PubMedCrossRef Abdollah F, Sun M, Schmitges J, Thuret R, Djahangirian O, Jeldres C, Tian Z, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI (2012) Development and validation of a reference table for prediction of postoperative mortality rate in patients treated with radical cystectomy: a population-based study. Ann Surg Oncol 19(1):309–317. doi:10.​1245/​s10434-011-1852-7 PubMedCrossRef
16.
go back to reference Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251PubMedCrossRef Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251PubMedCrossRef
18.
go back to reference D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49(12):1429–1433PubMedCrossRef D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49(12):1429–1433PubMedCrossRef
19.
go back to reference Ehlert BA, Durham CA, Parker FM, Bogey WM, Powell CS, Stoner MC (2011) Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers. J Vasc Surg 54(6):1629–1636. doi:10.1016/j.jvs.2011.05.116 PubMedCrossRef Ehlert BA, Durham CA, Parker FM, Bogey WM, Powell CS, Stoner MC (2011) Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers. J Vasc Surg 54(6):1629–1636. doi:10.​1016/​j.​jvs.​2011.​05.​116 PubMedCrossRef
20.
go back to reference Bergman S, Martelli V, Monette M, Sourial N, Deban M, Hamadani F, Teasdale D, Holcroft C, Zakrzewski H, Fraser S (2013) Identification of quality of care deficiencies in elderly surgical patients by measuring adherence to process-based quality indicators. J Am Coll Surg 217(5):858–866. doi:10.1016/j.jamcollsurg.2013.07.387 PubMedCrossRef Bergman S, Martelli V, Monette M, Sourial N, Deban M, Hamadani F, Teasdale D, Holcroft C, Zakrzewski H, Fraser S (2013) Identification of quality of care deficiencies in elderly surgical patients by measuring adherence to process-based quality indicators. J Am Coll Surg 217(5):858–866. doi:10.​1016/​j.​jamcollsurg.​2013.​07.​387 PubMedCrossRef
21.
go back to reference Ingraham AM (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148(4):625–635; discussion 635–627. doi:10.1016/j.surg.2010.07.025 Ingraham AM (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148(4):625–635; discussion 635–627. doi:10.​1016/​j.​surg.​2010.​07.​025
22.
go back to reference Colavita PD, Walters AL, Tsirline VB, Belyansky I, Lincourt AE, Kercher KW, Sing RF, Heniford BT (2013) The regionalization of ventral hernia repair: occurrence and outcomes over a decade. Am Surg 79(7):693–701PubMed Colavita PD, Walters AL, Tsirline VB, Belyansky I, Lincourt AE, Kercher KW, Sing RF, Heniford BT (2013) The regionalization of ventral hernia repair: occurrence and outcomes over a decade. Am Surg 79(7):693–701PubMed
25.
go back to reference Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(1):60–65 e61–e62. doi:10.1016/j.jamcollsurg.2009.09.034 Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(1):60–65 e61–e62. doi:10.​1016/​j.​jamcollsurg.​2009.​09.​034
28.
go back to reference Liverani A, Chiarot M, Bezzi M, Angelini L (1994) Is surgery duration really a complication factor? Minerva Chir 49(9):747–750PubMed Liverani A, Chiarot M, Bezzi M, Angelini L (1994) Is surgery duration really a complication factor? Minerva Chir 49(9):747–750PubMed
29.
go back to reference Dexter SP, Martin IG, Marton J, McMahon MJ (1997) Long operation and the risk of complications from laparoscopic cholecystectomy. Br J Surg 84(4):464–466PubMedCrossRef Dexter SP, Martin IG, Marton J, McMahon MJ (1997) Long operation and the risk of complications from laparoscopic cholecystectomy. Br J Surg 84(4):464–466PubMedCrossRef
30.
go back to reference Advani V, Ahad S, Gonczy C, Markwell S, Hassan I (2012) Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP. Am J Surg 203(3):347–351; discussion 351–342. doi:10.1016/j.amjsurg.2011.08.015 Advani V, Ahad S, Gonczy C, Markwell S, Hassan I (2012) Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP. Am J Surg 203(3):347–351; discussion 351–342. doi:10.​1016/​j.​amjsurg.​2011.​08.​015
31.
go back to reference Aguilar B, Sheikh F, Pockaj B, Wasif N, Gray R (2011) The effect of junior residents on surgical quality: a study of surgical outcomes in breast surgery. Am J Surg 202(6):654–657; discussion 657–658. doi:10.1016/j.amjsurg.2011.05.018 Aguilar B, Sheikh F, Pockaj B, Wasif N, Gray R (2011) The effect of junior residents on surgical quality: a study of surgical outcomes in breast surgery. Am J Surg 202(6):654–657; discussion 657–658. doi:10.​1016/​j.​amjsurg.​2011.​05.​018
33.
34.
go back to reference Naiditch JA, Lautz TB, Raval MV, Madonna MB, Barsness KA (2012) Effect of resident postgraduate year on outcomes after laparoscopic appendectomy for appendicitis in children. J Laparoendosc Adv Surg Tech A 22(7):715–719. doi:10.1089/lap.2012.0032 PubMedCrossRef Naiditch JA, Lautz TB, Raval MV, Madonna MB, Barsness KA (2012) Effect of resident postgraduate year on outcomes after laparoscopic appendectomy for appendicitis in children. J Laparoendosc Adv Surg Tech A 22(7):715–719. doi:10.​1089/​lap.​2012.​0032 PubMedCrossRef
38.
go back to reference Relles DM, Burkhart RA, Pucci MJ, Sendecki J, Tholey R, Drueding R, Sauter PK, Kennedy EP, Winter JM, Lavu H, Yeo CJ (2014) Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example. J Gastrointest Surg 18(2):279–285. doi:10.1007/s11605-013-2372-5 PubMedCrossRef Relles DM, Burkhart RA, Pucci MJ, Sendecki J, Tholey R, Drueding R, Sauter PK, Kennedy EP, Winter JM, Lavu H, Yeo CJ (2014) Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example. J Gastrointest Surg 18(2):279–285. doi:10.​1007/​s11605-013-2372-5 PubMedCrossRef
Metadata
Title
A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair
Authors
Samuel W. Ross
Bindhu Oommen
Mimi Kim
Amanda L. Walters
John M. Green
B. Todd Heniford
Vedra A. Augenstein
Publication date
01-11-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3586-7

Other articles of this Issue 11/2014

Surgical Endoscopy 11/2014 Go to the issue