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Fellowship has no negative effect on outcomes following foregut surgeries
Maria Altieri*, Jie Yang, Yaqi Xue, Dana A. Telem, Andrew Bates, Mark A. Talamini, Aurora Pryor
General Surgery, Stony Brook University Hospital, Stony Brook, NY
Introduction:
There is an increased trend towards subspecialization and an increased number of surgeons seeking fellowship training in the United States. Little is known regarding the effect of advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs on patient outcomes for foregut procedures. This study aims to examine the effect of advanced GI/MIS fellowship programs on perioperative outcomes across all institutions in the State of New York.
Methods:
Following IRB approval, the New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was used to identify several foregut procedures by using ICD-9 codes for inpatient procedures and CPT codes for outpatient procedures between 2012-2014. Procedures included fundoplication and Heller myotomy. Patients under 18 years old, with missing information, or with multiple surgery records during the same surgery were excluded from analysis. Esophageal procedures were compared in terms of 30-day readmission, hospital length of stay (HLOS), and major complications between institutions with and without fellowship. Facilities and the operating physicians were considered as two random effects to take into account of clustering nature of patients from the same facilities or the same physician. Univariate generalized linear mixed models were used to fit. P<0.05 was considered significant.
Results:
There were 3,175 foregut procedures identified from 2012-2014 in the State of New York, among which 1,041 (32.8%) were performed in hospitals with GI-MIS fellowship and 2134 (67.2%) were performed in hospitals without GI/MIS fellowship. When examining severe complications, after controlling for other factors, fellowship status of a hospital had no effect on outcomes in terms of severe complications (P-value= 0.1163). From the patients who underwent foregut procedures, only 154 (4.85%) had one 30-day readmission. No differences were seen in terms of 30-day readmissions between hospitals with or without GI/MIS fellowship, even after controlling for other risk factors (p=0.64 and p=0.25, respectively). Finally, although hospitals with GI/MIS fellowship had shorter LOS, there was no statistical significance in terms of HLOS after controlling for other risk factors (P-value-0.73).
Conclusion:
Fellowship training does not adversely impact patient outcomes following foregut procedures. Patients should be comfortable seeking care at institutions with training programs.
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