First Assistant Level of Training as a Predictor of Perioperative Outcomes in Primary Bariatric Surgery

Abstract

Introduction: Surgical education maintains sustainable and efficient health care. Previous studies have demonstrated inferior patient outcomes at teaching institutions. Many bariatric programs exist in teaching hospitals with varied first assistants (FAs). This study investigates the impact of FA level of training on outcomes in bariatric surgery. Methods: Patients ≥18 years old from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database who underwent bariatric surgery from 2015 to 2018 were included. The primary outcome was perioperative mortality. Secondary outcomes included postoperative surgical site infections (SSIs), conversion to open surgery, cardiovascular event, readmissions, nonoperative reintervention, and reoperation. Multivariate logistic regression was performed to assess differences in outcomes. Results: 670,935 bariatric operations met criteria for analysis. Resident assist was associated with marginally higher odds of mortality than use of advanced practice providers, fellows, or no assist, although overall mortality was low (0.1%) across the entire sample. Resident and fellow FAs were also associated with higher rates of SSI. Conclusions: FA level of training may be associated with perioperative outcomes in bariatric surgery. Further study can help address the impact of additional factors, including center- and surgeon-specific complication rates and socioeconomic status, on patient outcomes from surgeries with trainee FA.