COMPLICATIONS AND READMISSIONS ASSOCIATED WITH FIRST ASSIST TRAINING LEVEL FOLLOWING ELECTIVE BARIATRIC SURGERY
Tarik Yuce*, Amy Holmstrom, Eric S. Hungness, Ryan P. Merkow, Ezra Teitelbaum
Surgery, Northwestern Memorial Hospital, Chicago, IL
Introduction:
Little is known regarding the variation in training level and potential clinical impact of the first assist in bariatric surgery. We describe the postoperative 30-day complications and readmissions following elective laparoscopic sleeve gastrectomy (SG) and Roux-En-Y gastric bypass (RYGB) by training level of the first assistant.
Methods:
The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was used to identify patients who underwent elective SG and RYGB from 2015 to 2016. Patients were divided into four cohorts based on training level of the first assist (Attending, Fellow/Resident [PGY 1-5], Physician Assistant/Nurse Practitioner, None). Outcomes of interest included operative time (minutes), 30-day death or serious morbidity (DSM) as well as readmission. DSM is a composite of death as well as cardiovascular, respiratory, wound, and urinary complications. Differences in operative time were evaluated using Kruskal-Wallis analysis of variance. Multivariable logistic-regression models with robust standard errors, adjusting for patient characteristics and type of procedure, were estimated to examine differences in outcomes by first assist training level.
Results:
Of the 350,694 elective SG and RYGB performed between 2015 and 2016, the training level of the first assistant included 21.5% attending, 25.6% a fellow/resident, 38.2% PA/NP, and 14.7% with no first assist. Operative time (minutes) was significantly longer in the fellow/resident first assist cohort when compared to all other first assist cohorts (attending median 72 [interquartile range 50-103], fellow/resident 98 [71-134], PA/NP 73 [53-105], none 72 [52-103], p<0.001). Overall rates of 30-day DSM were low, ranging from 2.7-3.2%, while 30-day readmission rates ranged from 4.9-5.5%. Following adjustment for patient characteristics and type of procedure, first assist training level had no significant impact on DSM (fellow/resident OR 1.01, 95% CI 0.95-1.07, p=0.775, PA/NP OR 0.98, 95% CI 0.93-1.04 p=0.470, none OR 0.93, 95% CI 0.88-1.02, p=0.106) or readmission (fellow/resident OR 1.05, 95% CI 0.98-1.10, p=0.098, PA/NP OR 0.96, 95% CI 0.92-1.01 p=0.062, none OR 0.95, 95% CI 0.91-1.02, p=0.075) [Table 1]. Evaluation of DSM and readmission by procedure type as well as with fellows and residents as separate cohorts yielded similar results.
Conclusions:
Despite wide variation in training level of the first assist, we found no statistically significant differences in 30-day postoperative outcomes. These findings provide reassurance that the inclusion of trainees in bariatric procedures does not negatively impact clinical outcomes.
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