Skip to main content

Advertisement

SpringerLink
Log in

A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to analyze the effect of residents on patient outcomes in laparoscopic ventral hernia repair (LVHR).We hypothesized that increasing postgraduate year (PGY) level would correlate with better outcomes.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2011 for elective LVHR. Attending only cases were used as the control, and resident cases were stratified into junior (PGY 1–3), chief (4–5), and fellow (6+) cases. Standard statistical tests and multivariate regression controlling for age, body mass index, Charlson comorbidity index, smoking, functional status, and inpatient cases were performed for trainee involvement and PGY level.

Results

There were 6,841 ventral hernia repairs that met inclusion criteria: 2,773 attending and 4,068 resident cases. There were 1,644 junior, 1,983 chief, and 441 fellow cases. Patients were similar between the attending and resident groups. The resident group had a higher rate of inpatient cases, general complications, longer operative time, and hospital length of stay. After controlling for confounders in multivariate analysis, only operative time was significantly different; resident cases were 17.7 min longer (CI 15.0–20.6; p < 0.001). There was no significant difference in the rate of wound or major complications, readmission, reoperation, or mortality between attending and resident cases. Demographics were not significantly different between the PGY level strata. On multivariate regression by PGY level with attending alone as the reference, only operative time was significantly different. Juniors (15.7 min, CI 12.2–19.2), chiefs (18.0 min, CI 14.7–21.3), and fellows (24.9 min, CI 19.1–30.7) had significantly longer cases than attending alone; all p < 0.001.

Conclusion

Trainee involvement during LVHR does not change the clinical outcomes for patients as compared to those performed by an attending only. Operative time is significantly longer with increasing PGY level, perhaps indicating the complexity of the operation or increasing trainee involvement as primary surgeon. However, patient care does not suffer, affirming the current surgical training curriculum is appropriate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Farnan JM, Petty LA, Georgitis E, Martin S, Chiu E, Prochaska M, Arora VM (2012) A systematic review: the effect of clinical supervision on patient and residency education outcomes. Acad Med 87(4):428–442. doi:10.1097/ACM.0b013e31824822cc

    Article  PubMed  Google Scholar 

  2. Raval MV, Wang X, Cohen ME, Ingraham AM, Bentrem DJ, Dimick JB, Flynn T, Hall BL, Ko CY (2011) The influence of resident involvement on surgical outcomes. J Am Coll Surg 212(5):889–898. doi:10.1016/j.jamcollsurg.2010.12.029

    Article  PubMed  Google Scholar 

  3. Krell RW, Birkmeyer NJ, Reames BN, Carlin AM, Birkmeyer JD, Finks JF, Michigan Bariatric Surgery Collaborative (2014) Effects of resident involvement on complication rates after laparoscopic gastric bypass. J Am Coll Surg 218(2):253–260. doi:10.1016/j.jamcollsurg.2013.10.014

    Article  PubMed  Google Scholar 

  4. Fischer JP, Wes AM, Kovach SJ (2014) The impact of surgical resident participation in breast reduction surgery—outcome analysis from the 2005–2011 ACS-NSQIP datasets. J Plast Surg Hand Surg. doi:10.3109/2000656X.2014.882345

    Google Scholar 

  5. Kern SQ, Lustik MB, McMann LP, Thibault GP, Sterbis JR (2014) Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program. J Endourol/Endourol Soc 28(1):40–47. doi:10.1089/end.2013.0051

    Article  Google Scholar 

  6. Iannuzzi JC, Rickles AS, Deeb AP, Sharma A, Fleming FJ, Monson JR (2013) Outcomes associated with resident involvement in partial colectomy. Dis Colon Rectum 56(2):212–218. doi:10.1097/DCR.0b013e318276862f

    Article  PubMed  Google Scholar 

  7. Iannuzzi JC, Chandra A, Rickles AS, Kumar NG, Kelly KN, Gillespie DL, Monson JR, Fleming FJ (2013) Resident involvement is associated with worse outcomes after major lower extremity amputation. J Vasc Surg 58(3):827–831 e821. doi:10.1016/j.jvs.2013.04.046

  8. Castleberry AW, Clary BM, Migaly J, Worni M, Ferranti JM, Pappas TN, Scarborough JE (2013) Resident education in the era of patient safety: a nationwide analysis of outcomes and complications in resident-assisted oncologic surgery. Ann Surg Oncol 20(12):3715–3724. doi:10.1245/s10434-013-3079-2

    Article  PubMed  Google Scholar 

  9. Schoenfeld AJ, Serrano JA, Waterman BR, Bader JO, Belmont PJ Jr (2013) The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg 133(11):1483–1491. doi:10.1007/s00402-013-1841-3

    Article  PubMed  Google Scholar 

  10. Hernández-Irizarry R (2012) Impact of resident participation on laparoscopic inguinal hernia repairs: are residents slowing us down? J Surg Educ 69(6):746–752. doi:10.1016/j.jsurg.2012.08.013

    Article  PubMed  Google Scholar 

  11. Surgeons ACo (2014) NSQIP FAQS. http://site.acsnsqip.org/join-now/faq/

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  13. Birim O, Maat AP, Kappetein AP, van Meerbeeck JP, Damhuis RA, Bogers AJ (2003) Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer. Eur J Cardio-thorac Surg 23(1):30–34

    Article  CAS  Google Scholar 

  14. Abdollah F, Sun M, Schmitges J, Thuret R, Djahangirian O, Jeldres C, Tian Z, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI (2012) Development and validation of a reference table for prediction of postoperative mortality rate in patients treated with radical cystectomy: a population-based study. Ann Surg Oncol 19(1):309–317. doi:10.1245/s10434-011-1852-7

    Article  PubMed  Google Scholar 

  15. Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC (2006) Predictive indices of morbidity and mortality after liver resection. Ann Surg 243(3):373–379. doi:10.1097/01.sla.0000201483.95911.08

    Article  PubMed  PubMed Central  Google Scholar 

  16. Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251

    Article  PubMed  CAS  Google Scholar 

  17. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57(12):1288–1294. doi:10.1016/j.jclinepi.2004.03.012

    Article  PubMed  Google Scholar 

  18. D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49(12):1429–1433

    Article  PubMed  Google Scholar 

  19. Ehlert BA, Durham CA, Parker FM, Bogey WM, Powell CS, Stoner MC (2011) Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers. J Vasc Surg 54(6):1629–1636. doi:10.1016/j.jvs.2011.05.116

    Article  PubMed  Google Scholar 

  20. Bergman S, Martelli V, Monette M, Sourial N, Deban M, Hamadani F, Teasdale D, Holcroft C, Zakrzewski H, Fraser S (2013) Identification of quality of care deficiencies in elderly surgical patients by measuring adherence to process-based quality indicators. J Am Coll Surg 217(5):858–866. doi:10.1016/j.jamcollsurg.2013.07.387

    Article  PubMed  Google Scholar 

  21. Ingraham AM (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148(4):625–635; discussion 635–627. doi:10.1016/j.surg.2010.07.025

  22. Colavita PD, Walters AL, Tsirline VB, Belyansky I, Lincourt AE, Kercher KW, Sing RF, Heniford BT (2013) The regionalization of ventral hernia repair: occurrence and outcomes over a decade. Am Surg 79(7):693–701

    PubMed  Google Scholar 

  23. Kim BD, Hsu WK, De Oliveira GS Jr, Saha S, Kim JY (2013) Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: an analysis of 4,588 surgical cases. Spine. doi:10.1097/BRS.0000000000000163

    PubMed Central  Google Scholar 

  24. Jackson TD, Wannares JJ, Lancaster RT, Rattner DW, Hutter MM (2011) Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc 25(7):2288–2295. doi:10.1007/s00464-010-1550-8

    Article  PubMed  PubMed Central  Google Scholar 

  25. Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(1):60–65 e61–e62. doi:10.1016/j.jamcollsurg.2009.09.034

  26. Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, Kyaw MH (2013) A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One 8(12):e83743. doi:10.1371/journal.pone.0083743

    Article  PubMed  PubMed Central  Google Scholar 

  27. Scheer A, Martel G, Moloo H, Sabri E, Poulin EC, Mamazza J, Boushey RP (2009) Laparoscopic colon surgery: does operative time matter? Dis Colon Rectum 52(10):1746–1752. doi:10.1007/DCR.0b013e3181b55616

    Article  PubMed  Google Scholar 

  28. Liverani A, Chiarot M, Bezzi M, Angelini L (1994) Is surgery duration really a complication factor? Minerva Chir 49(9):747–750

    PubMed  CAS  Google Scholar 

  29. Dexter SP, Martin IG, Marton J, McMahon MJ (1997) Long operation and the risk of complications from laparoscopic cholecystectomy. Br J Surg 84(4):464–466

    Article  PubMed  CAS  Google Scholar 

  30. Advani V, Ahad S, Gonczy C, Markwell S, Hassan I (2012) Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP. Am J Surg 203(3):347–351; discussion 351–342. doi:10.1016/j.amjsurg.2011.08.015

  31. Aguilar B, Sheikh F, Pockaj B, Wasif N, Gray R (2011) The effect of junior residents on surgical quality: a study of surgical outcomes in breast surgery. Am J Surg 202(6):654–657; discussion 657–658. doi:10.1016/j.amjsurg.2011.05.018

  32. Papandria D, Rhee D, Ortega G, Zhang Y, Gorgy A, Makary MA, Abdullah F (2012) Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. J Surg Educ 69(2):149–155. doi:10.1016/j.jsurg.2011.08.003

    Article  PubMed  Google Scholar 

  33. Kiran RP, Ahmed Ali U, Coffey JC, Vogel JD, Pokala N, Fazio VW (2012) Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program. Ann Surg 256(3):469–475. doi:10.1097/SLA.0b013e318265812a

    Article  PubMed  Google Scholar 

  34. Naiditch JA, Lautz TB, Raval MV, Madonna MB, Barsness KA (2012) Effect of resident postgraduate year on outcomes after laparoscopic appendectomy for appendicitis in children. J Laparoendosc Adv Surg Tech A 22(7):715–719. doi:10.1089/lap.2012.0032

    Article  PubMed  Google Scholar 

  35. Jan A, Riggs DR, Orlando KL, Khan FJ (2012) Surgical outcomes based on resident involvement: what is the impact on vascular surgery patients? J Surg Educ 69(5):638–642. doi:10.1016/j.jsurg.2012.06.012

    Article  PubMed  Google Scholar 

  36. Davis SS Jr, Husain FA, Lin E, Nandipati KC, Perez S, Sweeney JF (2013) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg 216(1):96–104. doi:10.1016/j.jamcollsurg.2012.08.014

    Article  PubMed  Google Scholar 

  37. Uecker J, Luftman K, Ali S, Brown C (2013) Comparable operative times with and without surgery resident participation. J Surg Educ 70(6):696–699. doi:10.1016/j.jsurg.2013.06.011

    Article  PubMed  Google Scholar 

  38. Relles DM, Burkhart RA, Pucci MJ, Sendecki J, Tholey R, Drueding R, Sauter PK, Kennedy EP, Winter JM, Lavu H, Yeo CJ (2014) Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example. J Gastrointest Surg 18(2):279–285. doi:10.1007/s11605-013-2372-5

    Article  PubMed  Google Scholar 

  39. Hernandez-Irizarry R, Zendejas B, Ali SM, Lohse CM, Farley DR (2012) Impact of resident participation on laparoscopic inguinal hernia repairs: are residents slowing us down? J Surg Educ 69(6):746–752. doi:10.1016/j.jsurg.2012.08.013

    Article  PubMed  Google Scholar 

Download references

Disclosures

Vedra A. Augenstein received consulting fee and honoraria from Ethicon Inc. and honoraria for speaking from Davol Inc. B. Todd Heniford received consulting fee and honoraria from Ethicon Inc. and W.L. Gore & Associates Inc. LifeCell Corp. Industry supported research. DePuy Synthes Industry supported research. Samuel W. Ross, Bindhu Oommen, Mimi Kim, Joel F. Bradley, Kristopher B. Williams, Amanda L. Walters and John M. Green have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    Samuel W. Ross, Bindhu Oommen, Mimi Kim, Amanda L. Walters, John M. Green, B. Todd Heniford & Vedra A. Augenstein

Authors
  1. Samuel W. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bindhu Oommen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mimi Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amanda L. Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John M. Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Todd Heniford
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vedra A. Augenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vedra A. Augenstein.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ross, S.W., Oommen, B., Kim, M. et al. A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair. Surg Endosc 28, 3092–3100 (2014). https://doi.org/10.1007/s00464-014-3586-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3586-7

Keywords

Search

Navigation