Resident Participation as Co-Surgeon Does Not Adversely Impact Patient Outcomes in Pancreatic Surgery

Abstract

In academic settings, surgical residents often serve as co-surgeon in complex operations such as pancreatic resections. These operations are typically performed by fellowship-trained primary surgeons with extensive experience in the field. Our study aimed to evaluate how the participation of general surgery residents in these complex operations affected patient outcomes. Our hypothesis was that resident involvement as co-surgeon would not adversely impact key patient outcomes including complications, readmission, and mortality. A REDCap database of perioperative variables for patients undergoing pancreatic resection was established at a single independent academic medical center. The database was populated via retrospective chart review. Patient demographics, surgical indications, operative time, estimated blood loss, postoperative hospital length of stay, intensive care unit length of stay, postoperative complications, and 30- and 90-day survival for patients with and without cancer were reviewed. We further categorized the data based on the designation of a general surgery resident or a second staff surgeon as co-surgeon in each operation. The study was performed at the Marshfield Clinic Health System-Marshfield Medical Center, an independent academic medical center located in central Wisconsin. Data were abstracted from the medical records of all adult patients (18 years of age and older) who underwent pancreatic resection from 2007 to 2018 (n = 173). 173 pancreatic resections were performed by 8 different primary staff surgeons over 10.5 years. All co-surgeons were either another staff surgeon or a senior-level (postgraduate year 4 or 5) general surgery resident. Perioperative and postoperative patient outcomes were statistically similar in both groups. Resident involvement as co-surgeon in complex pancreatic resections constituted no increased risk for patients at our institution. Senior residents should continue to operate on these important learning cases under appropriate staff supervision.