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Is resident assistance equivalent to fellows during hepatectomy?

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Abstract

Objective

Hepatectomy is a complex operative procedure frequently performed at academic institutions with trainee participation. The aim of this study was to determine the effect of assistant’s training level on outcomes following hepatectomy.

Methods

A retrospective review of a prospective, single-institution ACS-NSQIP database was performed for patients that underwent hepatectomy (2013–2016). Patients were divided by trainee assistant level: hepatopancreatobiliary (HPB) fellow versus general surgery resident (PGY 4–5). Demographic, perioperative, and 30-day outcome variables were compared using Chi-Square/Fisher’s exact, Mann–Whitney U test, and multivariable regression. Cases involving a senior-level general surgery resident or HPB fellow as first assistant were included (n = 352). Those with a second attending, junior-level resident, or no documented assistant were excluded (n = 39).

Results

Patients undergoing hepatectomy with an HPB fellow as primary assistant had more frequent preoperative biliary stenting, longer operative time, and more concomitant procedures including biliary reconstruction, resulting in a higher rate of post-hepatectomy liver failure (PHLF) (15% vs. 8%, P = 0.044). However, trainee level did not impact PHLF on multivariable analysis (OR 0.60, 95% CI [0.29–1.25], P = 0.173). Fellows assisted with proportionally more major hepatectomies (45% vs. 31%; P = 0.010) and resections for hepatobiliary cancers (31% vs. 19%, P = 0.014). On stratified analysis of major and minor hepatectomies, outcomes were similar between trainee groups.

Conclusion

Fellows performed higher complexity cases with longer operative time. Despite these differences, outcomes were similar regardless of assistant training level. Resident and HPB fellow participation in operations requiring liver resection provide comparable quality of care.

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Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

DVT:

Deep venous thrombosis

HPB:

Hepatopancreatobiliary

ISGLS:

International Study Group of Liver Surgery

MELD:

Model for End-Stage Liver Disease Score

PGY:

Post-graduate-year

PHLF:

Post-hepatectomy liver failure

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall 541, Indianapolis, IN, 46202, USA

    Rachel E. Simpson, Kyle L. Carpenter, Christine Y. Wang, Christian M. Schmidt, E. Molly Kilbane, Michael G. House, Nicholas J. Zyromski, C. Max Schmidt, Attila Nakeeb & Eugene P. Ceppa

  2. Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Cameron L. Colgate

Authors
  1. Rachel E. Simpson
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  2. Kyle L. Carpenter
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  3. Christine Y. Wang
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  4. Christian M. Schmidt
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  5. E. Molly Kilbane
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  6. Cameron L. Colgate
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  7. Michael G. House
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  8. Nicholas J. Zyromski
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  9. C. Max Schmidt
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  11. Eugene P. Ceppa
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Correspondence to Eugene P. Ceppa.

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Disclosures

RE Simpson, KL Carpenter, CY Wang, CM Schmidt II, EM Kilbane, CL Colgate, MG House, NJ Zyromski, CM Schmidt, A Nakeeb, and EP Ceppa have no conflicts of interest or financial ties to disclose.

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Simpson, R.E., Carpenter, K.L., Wang, C.Y. et al. Is resident assistance equivalent to fellows during hepatectomy?. Surg Endosc 35, 260–269 (2021). https://doi.org/10.1007/s00464-020-07388-9

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  • DOI: https://doi.org/10.1007/s00464-020-07388-9

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