S. J. Davidson1, M. Rojnica2, A. J. Langerman2 1University Of Chicago,Pritzker School Of Medicine,Chicago, IL, USA 2University Of Chicago,Department Of Surgery,Chicago, IL, USA
Introduction:
Complex procedures often have numerous acceptable approaches; it is unclear how surgical fellows choose between these techniques. We used pancreaticoduodenectomy as a model procedure to catalogue the variability between surgeons within an affiliated health system and investigate the factors that affect fellow’s acquisition of techniques.
Methods:
Semi-structured interviews and operative note analysis were conducted to determine techniques of five attending surgeons, and these data were mapped to identify variations. Identical interviews and subsequent questioning were completed with four recent fellowship graduates whose current practice included pancreaticoduodenectomy.
Results:
All surgeons performed a different operation, both in order and techniques employed. Based on minor variations, there were actually 21 surgical step data points that differed – far more than previously recognized. Four of five surgeons were unable to identify colleagues’ techniques. Fellows reported that they were more likely to adopt techniques from mentors who had regimented techniques, teaching styles they related to, and with whom they frequently operated. Fellows did not feel residency training had a strong influence on their choice of technique, but did report a moderate influence from senior partners after fellowship.
Conclusion:
The true number of variants of pancreaticoduodenectomy based on granular, step-by-step difference is substantially larger than previously described. Results hint that variation may be furthered by the fact that surgeons may not be intimately aware of the techniques employed by colleagues. Interestingly, fellows appear to choose techniques based on factors not directly related to their own outcomes, but rather mentors’ techniques and teaching style. Whether fellows adopt the techniques that will be most optimal given their abilities is worthy of further investigation, as are changes in technique over time. Better codification of surgical variation is needed to facilitate these investigations as well as matching of technical variations to patient outcomes.
