L. R. Taveras Morales1, J. Imran1, O. Renteria1, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 2VA North Texas Health Care System,Department Of Surgery,Dallas, TX, USA
Introduction: Cholecystectomy is one of the most common operations performed in general surgery. Prior studies have shown no difference in outcomes after cholecystectomy between attending surgeons and resident physicians; however, there is a paucity of data comparing outcomes between senior- and junior-level residents. The aim of this study was to compare intraoperative and postoperative outcomes after cholecystectomy between the latter two groups.
Methods: A retrospective chart review was performed of all cholecystectomies performed over a 10-year period at the Veterans Affairs North Texas Health Care System. Procedures completed during gastric bypass or for cancer were excluded. Cohorts were divided into intern or postgraduate year (PGY) 2-3 residents and senior-level residents (PGY 4-5). Categorical and continuous data were analyzed using chi-squared and Student’s t tests where appropriate.
Results: Overall, 721 cholecystectomies were performed during the study period, with 442 (61.3%) done by PGY 1-3 residents and 279 (38.7%) by PGY 4-5 residents. There was no difference in patient demographics between the two groups, including on measures of age, gender, race, and ASA classification. Comorbidities were similar between groups except for a history of myocardial infarction (MI), which was more common in the patients operated on by junior-level residents (8.3% vs. 4.3%; p = 0.03).
When comparing estimated blood loss, operative time, or conversion rate there was no difference between cohorts. Patients operated on by senior-level residents had a higher incidence of postoperative abscess (2.5% vs. 0.4%; p=0.01) and urinary tract infection (2.5% vs. 0.68%; p=0.04), while patients operated on by junior-level residents had a shorter length of stay (3.2 days vs. 4.5 days; p<0.01). There was no difference in 30-day morbidity, mortality, or postoperative complications such as pneumonia, biloma, postoperative MI or renal failure.
Conclusion: There is no difference in major complications based on PGY-level following cholecystectomy. While no statistic difference in patient demographics were noted, the observed higher rate of minor complications and LOS might be a reflection of senior residents undertaking more challenging cases of gallbladder disease.