Impact of resident participation on perioperative outcomes in index laparoscopic general surgical cases: An analysis using the American College of Surgeons/ National Surgical Quality Improvement Program (ACS/NSQIP) Participant Use File (PUF)

Abstract

Introduction The current study was undertaken using the ACS/ NSQIP PUF file, to evaluate the impact of resident participation on perioperative outcomes for index laparoscopic surgeries. Methods Six index laparoscopic procedures were selected (appendectomy, cholecystectomy, gastric bypass, fundoplication, colectomy, inguinal hernia). A retrospective review of the ACS/NSQIP PUF file yielded 79,720 cases. Demographics, preoperative comorbidities, and ASA class, operative time, hospital length of stay, mortality, morbidity, and return to OR were assessed. An initial analysis comparing case outcomes with/without resident participation was undertaken. A subset analysis was undertaken by dividing the data set into junior (PGY 1-2), senior (PGY 3-5), or fellow (PGY >5) groups. A p-value of Results The demographics, preoperative comorbidities, and ASA classes were clinically similar between groups. Operative times were 20-47% longer with resident participation, with basic procedures having greater differences (e.g.: laparoscopic cholecystectomy and laparoscopic appendectomy). Mortality and return to the OR were not clinically different. Morbidity rates were similar, although advanced procedures had rates that were higher with resident participation (15.5% vs 12.4% for colectomy and 5.2% vs 4.0% for gastric bypass). On subset analysis, participation of senior residents was associated with longer operative times. Conclusions Operative times for laparoscopic procedures significantly increase with resident participation. Operative times are longer for senior residents implying greater resident involvement in the procedure. Outcomes are largely equivalent, although there are slightly higher morbidity rates with advanced procedures. This study supports resident participation but stresses the need to develop training techniques that occur outside the OR.