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Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity

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Abstract

Background

Surgical trainee association with operative outcomes is controversial. Studies are conflicting, possibly due to insufficient control of confounding variables such as operative time, case complexity, and heterogeneous patient populations. As operative complications worsen long-term outcomes in oncologic patients, understanding effect of trainee involvement during laparoscopic colectomy for cancer is of utmost importance. Here, we hypothesized that resident involvement was associated with worsened 30-day mortality and 30-day overall morbidity in this patient population.

Methods

Patients undergoing laparoscopic colectomy for oncologic diagnosis from 2005 to 2012 were assessed using the American College of Surgeons National Surgical Quality Improvement Program dataset. Propensity score matching accounted for demographics, comorbidities, case complexity, and operative time. Attending only cases were compared to junior, middle, chief resident, and fellow level cohorts to assess primary outcomes of 30-day mortality and 30-day overall morbidity.

Results

A total of 13,211 patients met inclusion criteria, with 4075 (30.8%) cases lacking trainee involvement and 9136 (69.2%) involving a trainee. Following propensity matching, junior (PGY 1–2) and middle level (PGY 3–4) resident involvement was not associated with worsened outcomes. Chief (PGY 5) resident involvement was associated with worsened 30-day overall morbidity (15.5 vs. 18.6%, p = 0.01). Fellow (PGY > 5) involvement was associated with worsened 30-day overall morbidity (16.0 vs. 21.0%, p < 0.001), serious morbidity (9.3 vs. 13.5%, p < 0.001), minor morbidity (9.8 vs. 13.1%, p = 0.002), and surgical site infection (7.9 vs. 10.5%, p = 0.006). No differences were seen in 30-day mortality for any resident level.

Conclusion

Following propensity-matched analysis of cancer patients undergoing laparoscopic colectomy, chief residents, and fellows were associated with worsened operative outcomes compared to attending along cases, while junior and mid-level resident outcomes were no different. Further study is necessary to determine what effect the PGY surgical trainee level has on post-operative morbidity in cancer patients undergoing laparoscopic colectomy in the context of multiple collinear factors.

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Authors and Affiliations

  1. Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA

    Adam C. Celio, Lauren Trakimas, Mark L. Manwaring & Konstantinos Spaniolas

  2. Department of Surgery, Carolinas HealthCare System, 1025 Morehead Medical Dr, STE 300, Charlotte, NC, 28204, USA

    Kevin R. Kasten

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  1. Kevin R. Kasten
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  2. Adam C. Celio
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Contributions

KRK had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: KRK, ACC, LT, KS. Acquisition of data: KRK, ACC, LT, KS. Analysis and interpretation of data: KRK, ACC, LT, KS. Drafting of the manuscript: KRK, ACC, LT, MLM, KS. Critical revision of the manuscript: KRK, ACC, LT, MLM, KS. Study supervision: KRK.

Corresponding author

Correspondence to Kevin R. Kasten.

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Kasten, Celio, Trakimas, Manwaring, and Spaniolas have no conflicts of interest or financial ties to disclose.

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Kasten, K.R., Celio, A.C., Trakimas, L. et al. Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity. Surg Endosc 32, 702–711 (2018). https://doi.org/10.1007/s00464-017-5726-3

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