C. L. Devin1, G. S. Chevrollier1, S. L. Savitch1, S. L. Rakestraw1, M. J. Pucci1, K. A. Chojnacki1, F. Palazzo1 1Thomas Jefferson University Hospital,Department Of Surgery,Philadelphia, PA, USA
Introduction:
With increasing financial pressures in healthcare, intense scrutiny is being placed on cost-containment while optimizing patient outcomes. Resident involvement in surgery has been associated with prolonged operative times without associated increases in complications. Laparoscopic inguinal hernia repairs (LIHR) are increasingly common yet complex procedures for trainees. As such, resident impact on LIHR remains unknown. We sought to determine if resident involvement impacted perioperative outcomes of elective LIHR.
Methods:
We retrospectively identified all patients who had undergone elective LIHR at our institution between May 2015 and April 2017. We divided these patients into three groups based on resident involvement and resident year (Group 1 (n=48) =no resident; Group 2 (n=75) =PGY1-2; Group 3 (n=89) =PGY4+). Outcomes evaluated included operative time, estimated blood loss (EBL), length of stay (LOS), 30-day complications, and 30-day readmissions (including visits to the emergency department.) Chi-square and t-tests were performed to determine statistical significance, which was set at p<0.05.
Results:
We identified 212 patients with an average age of 55 years. Of these patients, 96% were male and 40% underwent repair of bilateral hernias. Perioperative outcomes are described in Table 1. Group 1 had significantly lower average operative times and mean EBL compared to group 2 (38 min vs 75 mins, p<0.01; 5 mL vs 10 mL, p<0.01) and group 3 (38 min vs 74 min; 5 mL vs 10 mL, p<0.01). Median LOS, measured as the time anesthesia ended to the time of discharge, was not significantly different between the three groups (p=0.40). Ten percent of patients developed complications, with the majority being urinary retention (n=15, 7%). LOS and 30-day complications did not differ significantly between groups. The 30-day readmission rate was 10% in group 1 compared to 5% and 4% in groups 2 and 3; these differences were not significant (p=0.36).
Conclusion:
Despite longer operative times and clinically insignificant higher EBL, resident involvement in elective LIHR is not associated with increased LOS, 30-day complications, or readmissions. Long-term implications require further investigation.
