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Effect modification of resident autonomy and seniority on perioperative outcomes in laparoscopic cholecystectomy

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Abstract

Background

Resident operative involvement is an integral aspect of general surgery residency training. However, current data examining the effect of resident autonomy on perioperative outcomes remain limited.

Methods

Patient and operator-specific data were collected from 344 adult laparoscopic cholecystectomies at a tertiary academic institution and its regional affiliates between 2018 and 2019. Multivariate modeling compared postoperative outcomes between cases completed with or without resident involvement and its effect modification by resident seniority and autonomy per Zwisch scale. Outcomes include 30-day postoperative complications, hospital readmission rate, and operative time.

Results

Multivariate analysis revealed resident involvement in laparoscopic cholecystectomy did not significantly change odds of 30-day postoperative complications (OR 2.52, p = 0.185, 95% CI 0.64–9.92) or hospital readmission (OR 1.61, p = 0.538, 95% CI 0.36–7.23). Operative time is significantly increased compared to faculty-only cases (IRR 1.37, p < 0.001, 95% CI 1.26–1.48). While accounting for case difficulty and resident performance evaluated by SIMPL criteria, stratification by resident autonomy measured by Zwisch scale or seniority reveal no effect modification on 30-day postoperative complications, readmissions, or operative time. The effect of resident involvement on longer relative rates of operative time loses its significance in supervision-only cases (IRR 1.18, p = 0.069, 95% CI 0.99–1.41).

Conclusion

While resident involvement and autonomy are associated with significantly longer operative times in laparoscopic cholecystectomy, their lack of significant effect on postoperative outcomes argues strongly for continued resident involvement and supervised operative independence.

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Funding

All authors (Drs. Shin, Naples, French, Khandelwal, Rose, Alaedeen, Dai, Lipman, Rosen, and Petro) report no external funding source for this study.

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Authors and Affiliations

  1. Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Thomas H. Shin, Robert Naples, Judith C. French, Cathleen M. Khandelwal, Warren Rose, Diya Alaedeen, Jie Dai, Jeremy Lipman, Michael J. Rosen & Clayton Petro

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Robert Naples, Judith C. French, Jeremy Lipman, Michael J. Rosen & Clayton Petro

  3. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA

    Thomas H. Shin

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  1. Thomas H. Shin
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Correspondence to Thomas H. Shin.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Drs. Shin, Naples, French, Khandelwal, Rose, Alaedeen, Dai, Lipman, Rosen, and Petro have no conflicts of interests or financial ties to disclose.

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Shin, T.H., Naples, R., French, J.C. et al. Effect modification of resident autonomy and seniority on perioperative outcomes in laparoscopic cholecystectomy. Surg Endosc 35, 3387–3397 (2021). https://doi.org/10.1007/s00464-020-07780-5

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  • DOI: https://doi.org/10.1007/s00464-020-07780-5

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