Surgery in Practice and Science (Mar 2022)
Residents versus minimally invasive surgery fellows as first assistant: Outcome differences for laparoscopic Roux-en-Y gastric bypass
Abstract
Introduction: : Determining when a trainee can perform technically challenging bariatric operations can be difficult. Laparoscopic Roux-en-Y gastric bypass operations performed by residents were compared to fellows to determine if surgical outcomes were comparable. Materials and Methods: : Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data (January 1, 2015 - December 31, 2018) were analyzed in this retrospective study. Categorical variables were analyzed with Chi-square test. Continuous variables are presented as means with standard deviations and analyzed with Student's t-test. Results: :Residents (R) assisted in 79 (42%) cases as surgeon while fellows (F) assisted in 109 (58%) cases. Patient age; sex; BMI kg/m2; and ASA ≥ 3 were comparable for both groups. Postoperative complications (R = 13%, F = 12%, p=0.83) and length of stay (R = 2.5 ± 1.9 days, F = 2.4 ± 0.8 days, p=0.62) were similar between groups as were unplanned 30-day readmissions (R=6% vs F=7%, p=0.78) and reoperations (R=3% vs F=1%, p=0.31). Duration of operation was longer for residents (173 ± 52.3 minutes) than fellows (166 ± 43.1 minutes, p=0.16) but not significantly different. Discussion: : While there have been several studies of bariatric surgery outcomes involving trainees, few have compared outcomes based on whether the assistant was a resident or a fellow. Operative times were similar for fellows and residents, in contrast to several other studies. We conclude that at our institution chief residents appear to be given similar autonomy to fellows, with fellows having slightly shorter operative duration as would be expected based on level of training. Conclusion: : In this study of laparoscopic Roux-en-Y gastric bypass patients at a single institution, no differences in post-operative complications, operative duration, length of stay, reoperation, or readmission were identified between cases performed with a resident versus minimally invasive surgery fellow. We conclude that trained chief residents can perform laparoscopic Roux-en-Y gastric bypass as first assistant with outcomes comparable to those of postgraduate fellows.
