L. Martin1,2, C. Zhang1, A. Presson1, R. Nirula1, W. Peche1,2, B. Brooke1,2 1University Of Utah,Salt Lake City, UT, USA 2VA Salt Lake City Health Care System,Salt Lake City, UT, USA
Introduction: Resident participation in operative cases within Veterans Administrative (VA) hospitals is often assumed to be associated with worse surgical outcomes. While recent studies have evaluated the association between resident post-graduate year (PGY) and perioperative morbidity, this metric fails to capture resident participation as a function of case-level involvement. We designed this study to examine resident participation as a function of training and case-level involvement on cholecystectomy performed at all PGY levels.
Methods: We identify all cholecystectomies performed at nationwide VA hospitals from 2005 to 2014 using surgical CPT codes and then requested the corresponding Veterans Affairs Surgical Quality Improvement Project (VASQIP) dataset. Resident participation was categorized (Levels 0-3) as a function of involvement as well as year of training (Table). We performed multivariate regression analyses to examine the effect of resident participation on operative time and composite metric of peri-operative complications (intra-op transfusion, return to OR, or organ space infection) after adjustment for surgical approach (laparoscopic vs. open), diagnosis (cholelithiasis vs. cholecystitis), patient comorbidities, perioperative physiology, and preoperative laboratory values.
Results: A total of 32,833 patients were identified as having undergone either laparoscopic (82%) or open (17%) cholecystectomy for either acute or chronic cholecystitis (74%) or symptomatic biliary disease (26%). Mean operative time was 102 min, and was found to be significantly increased for residents at each participation level when compared to an attending operating alone in multivariate models (Table). The peri-operative complication metric occurred in 1436 cases (4%), and was found to be significantly increased in univariate analysis for resident participation at levels 2 (OR 1.24; p<0.05) & level 3 (OR 1.35; p<0.05) as compared to an attending operating alone. However after adjusting for patient-level confounders in the multivariate model, resident participation level was not found to be significantly associated with a higher likelihood of peri-operative complications (Table).
Conclusion: While resident participation in cholecystectomy within VA hospitals is associated with increased operative time, there is no adverse effect on the rate of perioperative complications. These findings suggest that resident involvement achieves education and training objectives without sacrificing quality of care.
