Massachusetts Chapter of the American College of Surgeons

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The Impact of Trainee Involvement in Bariatric Surgery on Patient Outcomes
Darian Hoagland MD1,3, Jaisa Olasky MD1,2, Tara S Kent MD1,3, R. Wesley Vosburg MD1,2
1Harvard Medical School, Boston, MA; 2Department of Surgery Mount Auburn Hospital, Cambridge, MA; 3Department of Surgery Beth Israel Deaconess Medical Center, Boston MA

Background: The number of bariatric operations performed in the US rises annually. Trainees must receive adequate experience in this field to ensure competency in future surgical generations. However, the safety of trainee involvement of these operations has been called into question. The aim of our study is to describe differences in outcomes between trainees and non-trainees as first assistants (FA) in sleeve gastrectomy (SG).
Methods: Utilizing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, all patients who underwent primary SG from 2015-2020 were identified. Statistical analysis included two-tailed t-tests and ?2-tests to evaluate the impact of trainees (residents and fellows) compared to non-trainees on post-operative morbidity and operative time.
Results: Of the total 559,324 cases, 25.8% were performed with trainees as FA. Operative length was 27.9% longer in trainee cases. In the trainee group, there was a higher risk of conversion to open procedure (OR 1.32), readmission (OR 1.19), and specific complications (cardiac arrest, myocardial infarction, progressive renal insufficiency, pulmonary embolism, sepsis, transfusion, intubation, UTI, VTE, ICU admission, and reintervention), though overall rates were < 1% in each group. No significant difference was seen in all other perioperative outcomes.
Conclusion: Trainee involvement in SG leads to longer operative times, but overall is not associated with a clinically significant increase in morbidity and mortality. Such findings should be used to counsel patients and shape realistic expectations for surgeons and hospitals. There is a role for focused bariatric surgery curriculum to lessen this gap.


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