Abstract
to evaluate the effectiveness and safety of laparoscopic cholecystectomies performed by residents of the first and second-year of a general surgery residency program. We studied the primary total cost of treatment and complication rates as primary outcomes, comparing the groups operated by senior and resident surgeons. this was a retrospective cohort study of patients who underwent laparoscopic cholecystectomy performed in a training hospital of large surgical volume in Brazil, in the period between June 1, 2018 and May 31, 2019. The study population comprised patients who underwent elective cholecystectomy due to uncomplicated chronic calculous cholecystitis or to the presence of gallbladder polyps with surgical indication. We divided the cases into three groups, based on the graduation of the main surgeon at the time of the procedure: first-year residents (R1), second-year residents (R2), and trained general surgeons (GS). during the study period, 1,052 laparoscopic cholecystectomies were performed, of which 1,035 procedures met the inclusion criteria, with 78 (7.5%) patients operated on with the participation of first-year residents (R1), 500 (48.3%) patients with the participation of second-year residents (R2), and 457 (44.2%) with the participation of senior surgeons only. There was no difference in conversion rates, complications, and reporting of adverse events between groups. We observed a significant difference regarding hospitalization costs (p = 0.003), with a higher mean for the patients operated with the participation of R1, of US$ 2,671.13, versus US$ 2,414.60 and US$ 2,396.24 for the procedures performed by senior surgeons and R2, respectively. laparoscopic cholecystectomy with the participation of residents is safe, even in their first years of training. There is an additional cost of about 10% in the treatment of patient operated with the participation of first-year residents. There was no significant difference in the cost of the group operated by second-year residents.
Highlights
More than a century ago, William Stewart Halsted established one of the first surgery training programs, which was based on the concept of levels of responsibility of the so-called resident, based on his years of experience[1,2]
In addition to issues related to patient safety, there is a common perception that the resident’s involvement may have an economic impact[9,14,15]. This is a retrospective cohort study involving patients undergoing laparoscopic cholecystectomy performed in a training hospital of large surgical volume, the Vila Santa Catarina County Hospital, in the period between June 01, 2018 and May 31, 2019
As for associated diseases, we opted for the use of Severity of Illness (SOI) in the stratification of cases, since this score is commonly used to adjust the complexity of patients when it is intended to compare resource uses, rate of complications, and length of hospital stay between groups
Summary
More than a century ago, William Stewart Halsted established one of the first surgery training programs, which was based on the concept of levels of responsibility of the so-called resident, based on his years of experience[1,2]. The surgical community has debated the delicate balance between medical education and patient care[3]. The participation of residents in the operating room is a fundamental step in the training of the surgeon. Appendectomies, herniorrhaphies, and cholecystectomies are relatively simple surgical procedures that traditionally offer ample opportunity for residents to acquire basic training in their operative skills at a relatively early stage of their careers[5]. The replacement of open cholecystectomy by laparoscopic approach as a standard treatment for calculous gallbladder disease occurred in the early 1990s6. Laparoscopy is a challenging access route in terms of guidance, as supervision is often only vocal and requires major changes in operative settings for the tutor to intervene[3]
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