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Impact of Fellow vs. Resident Assistance on Outcomes Following Pancreaticoduodenectomy
Christian Schmidt, Andrea Jester*, Catherine Chung, Alexandra M. Roch, Rosalie Carr, E M. Kilbane, Michael G. House, Nicholas J. Zyromski, Attila Nakeeb, C. Max Schmidt, Eugene P. Ceppa
Surgery, Indiana University School of Medicine, Indianapolis, IN
Purpose: Participation by residents and fellows in procedures of higher complexity is key to their development as future practicing surgeons. The impact of experience on outcomes of pancreaticoduodenectomy (PD) has been clearly shown in a number of studies. The impact of surgical fellows vs. general surgery resident assistance in outcomes in PD has not been studied. The purpose of this study was to determine if there were significant differences in patient outcomes following pancreaticoduodenectomy as a function of hepatopancreatobiliary surgery fellow vs. general surgery resident intraoperative assistance.
Methods: Consecutive cases of PD (n=220) were reviewed at a single high-volume institution over an 18-month period (July 2013-December 2014). Inclusion criteria consisted of any patient who underwent a PD with involvement of a surgical trainee. Thirty-day outcomes were monitored through the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP); all PD are tracked using NSQIP. Quality In-Training Initiative (QITI) is a novel component of NSQIP with a variable that included documenting the PGY level of the trainee assisting in the case. As a result, we are able to distinguish the exact PGY level per case. Each faculty member performing PD is beyond the learning curve of 60 cases. Two-way statistical analyses were used to compare categories.
Results: The hepatopancreatobiliary surgery fellows and general surgery residents participated in n=98 and n=122, PD respectively. There were no statistical differences in demographics, BMI, ASA score, or any other preoperative variable between groups. Intraoperative variables were nearly identical: median operative time (275 + 10 vs. 285 + 10 minutes), rate of transfusion (25% vs. 25%), and mean units of blood transfused (4.1 + 0.3 vs. 5.1 + 0.65 units) for fellows vs. residents respectively. Post-operative outcomes were similar and are listed in the table.
Conclusions: These results suggest that in the training environment that either dedicated hepatopancreatobiliary surgery fellows or general surgery residents are of comparable safety as assistants to performing pancreaticoduodenectomy.
Table
| Operation Category | # patients | Mortality | Morbidity | All SSI | Sepsis | Pancreatic Fistula | Delayed Gastric Emptying | LOS (days) | Readmit Rate | | Fellow | 98 | 3% | 39% | 13% | 5% | 16% | 18% | 9.4 | 19% | | Resident | 122 | 2% | 45% | 14% | 7% | 16% | 12% | 9.6 | 18% |
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