Online citations, reference lists, and bibliographies.

Does Resident Experience Affect Outcomes In Complex Abdominal Surgery? Pancreaticoduodenectomy As An Example

Daniel M. Relles, R. Burkhart, M. Pucci, J. Sendecki, Renée M Tholey, R. Drueding, P. K. Sauter, E. Kennedy, J. Winter, H. Lavu, C. Yeo
Published 2013 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
ObjectivesUnderstanding the factors contributing to improved postoperative patient outcomes remains paramount. For complex abdominal operations such as pancreaticoduodenectomy (PD), the influence of provider and hospital volume on surgical outcomes has been described. The impact of resident experience is less well understood.MethodsWe reviewed perioperative outcomes after PD at a single high-volume center between 2006 and 2012. Resident participation and outcomes were collected in a prospectively maintained database. Resident experience was defined as postgraduate year (PGY) and number of PDs performed.ResultsForty-three residents and four attending surgeons completed 686 PDs. The overall complication rate was 44 %; PD-specific complications (defined as pancreatic fistula, delayed gastric emptying, intraabdominal abscess, wound infection, and bile leak) occurred in 28 % of patients. The overall complication rates were similar when comparing PGY 4 to PGY 5 residents (55.3 vs. 43.0 %; p > 0.05). On univariate analysis, there was a difference in PD-specific complications seen between a PGY 4 as compared to a PGY 5 resident (44 vs. 27 %, respectively; p = 0.016). However, this was not statistically significant when adjusted for attending surgeon. Logistic regression demonstrated that as residents perform more cases, PD-specific complications decrease (OR = 0.97; p < 0.01). For a resident's first PD case, the predicted probability of a PD-specific complication is 27 %; this rate decreases to 19 % by resident case number 15.ConclusionsComplex cases, such as PD, provide unparalleled learning opportunities and remain an important component of surgical training. We highlight the impact of resident involvement in complex abdominal operations, demonstrating for the first time that as residents build experience with PD, patient outcomes improve. This is consistent with volume–outcome relationships for attending physicians and high-volume hospitals. Maximizing resident repetitive exposure to complex procedures benefits both the patient and the trainee.
This paper references
D u o d e n o j e j u n o s t om y l e a k s a f t e r pancreaticoduodenectomy
JM Winter (2008)
S c h u l i c k RD . D u o d e n o j e j u n o s t om y l e a k s a f t e r pancreaticoduodenectomy
JM Winter (2008)
Appendectomy by Residents Is Safe and Not Associated With a Higher Incidence of Complications: A Retrospective Cohort Study
L. Graat (2012)
Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes.
James G. Reeves (2012)
Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following Pancreaticoduodenectomy
Richard A. Burkhart (2012)
Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution--the first step in multidisciplinary team building.
E. Kennedy (2007)
The role of deliberate practice in the acquisition of expert performance.
K. A. Ericsson (1993)
Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy.
J. Birkmeyer (1999)
Effect of Surgeon Volume on Outcome Following Pancreaticoduodenectomy in a High-Volume Hospital
N. Pecorelli (2011)
Effect of resident postgraduate year on outcomes after laparoscopic appendectomy for appendicitis in children.
Jessica Ann Naiditch (2012)
Involvement of surgical trainees in surgery for colorectal cancer and their effect on outcome
D. Borowski (2008)
Effect of Hospital Volume and Experience on In-Hospital Mortality for Pancreaticoduodenectomy
V. Ho (2003)
Systematic review and meta‐analysis of the volume–outcome relationship in pancreatic surgery
G. A. Gooiker (2011)
Duodenojejunostomy Leaks After Pancreaticoduodenectomy
J. Winter (2007)
Importance of hospital volume in the overall management of pancreatic cancer.
J. Sosa (1998)
Defining the Impact of Resident Participation on Outcomes After Appendectomy
J. Scarborough (2012)
Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience.
C. Schmidt (2010)
The influence of resident involvement on surgical outcomes.
M. Raval (2011)
The "cost" of operative training for surgical residents.
T. Babineau (2004)
Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes.
T. Gordon (1999)
Surgeon Volume Impacts Hospital Mortality for Pancreatic Resection
Robert W. Eppsteiner (2009)
Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in California.
M. Hutter (2000)
The learning curve in pancreatic surgery (DOI: 10.1016/j.surg.2006.09.013)
J. Tseng (2007)
Assessment of the learning curve for pancreaticoduodenectomy.
W. Fisher (2012)
Rates of Complications and Death After Pancreaticoduodenectomy: Risk Factors and the Impact of Hospital Volume
D. Gouma (2000)
Reconstruction Following the Pylorus Preserving Whipple Resection: PJ, HJ, and DJ
Eugene P. Kennedy (2009)
Resident versus no resident: a single institutional study on operative complications, mortality, and cost.
C. Hwang (2008)
The learning curve in pancreatic surgery
Charlotte C. Sun DrPH (2007)
Hospital teaching status and outcomes of complex surgical procedures in the United States.
J. Dimick (2004)
Toward improving uniformity and standardization in the reporting of pancreatic anastomoses: a new classification system by the International Study Group of Pancreatic Surgery (ISGPS).
P. Shukla (2010)
Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP.
V. Advani (2012)
Postoperative pancreatic fistula: an international study group (ISGPF) definition.
C. Bassi (2005)
Relation of Perioperative Deaths to Hospital Volume Among Patients Undergoing Pancreatic Resection for Malignancy
M. Lieberman (1995)
Outcomes Associated With Resident Involvement in Partial Colectomy
James C. Iannuzzi (2013)
Supervised surgical trainees can perform pancreatic resections safely.
R. Praseedom (1999)
E f f e c t o f s u r g e on vo l ume on ou t c ome f o l l ow i n g pancreaticoduodenectomy in a high-volume hospital
N Pecorelli (2012)
Surgical resident involvement is safe for common elective general surgery procedures.
W. Tseng (2011)
Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes.
C. Yeo (1997)

This paper is referenced by
Disclosure of the Resident Role in the Interventional Radiology Suite: How Do Interventional Radiologists Balance Patient Care and Resident Education?
Rebecca Zener (2016)
Proctologic surgery done by residents - Complications preprogrammed?
T Schreckenbach (2016)
Training in endocrine surgery
O. Gimm (2019)
Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity
K. Kasten (2017)
Significance of Two Experienced Pancreatic Surgeons Cooperating in Pancreaticoduodenectomies
Bergthor Björnsson (2016)
The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections.
A. Ejaz (2015)
A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair
Samuel Ross (2014)
Differences in quality of surgery for advanced gastric cancer between institutions
Masahida Ikeguchi (2015)
Deconstructing the “July Effect” in Operative Outcomes: A National Study
Ammara A. Watkins (2016)
Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons
Alexander Reinisch (2016)
Can physician gestalt predict survival in patients with resectable pancreatic adenocarcinoma?
Linda M. Pak (2017)
Postoperative day 3 drain amylase versus fistula risk score: predicting clinically relevant postoperative pancreatic fistula following pancreatico-duodenectomy
Nagesh Nayakarahally Swamy Gowda (2019)
Resident Participation as Co-Surgeon Does Not Adversely Impact Patient Outcomes in Pancreatic Surgery.
Shelley A Gabel (2020)
Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients.
Mohamad Bydon (2015)
Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator.
Brian M. Cusworth (2017)
Spine surgery training: is it time to consider categorical spine surgery residency?
A. Daniels (2015)
The impact of surgical experience and frequency of practice on perioperative outcomes in pancreatic surgery
C. Krautz (2019)
Vessel ligation training via an adaptive simulation curriculum.
Yinin Hu (2015)
Number of acinar cells at the pancreatic stump predicts pancreatic fistula after pancreaticoduodenectomy
Naoki Umezaki (2018)
La chirurgie proctologique faite par les chirurgiens en formation. Morbidité programmée
Teresa Schreckenbach (2016)
Impact of resident surgeons on procedure length based on common pediatric otolaryngology cases.
Sidharth V Puram (2015)
Impact of Fellow Versus Resident Assistance on Outcomes Following Pancreatoduodenectomy
R. A. Carr (2017)
Resident exposure to complex surgery while ensuring patient safety.
Tetsuji Fujita (2015)
Biliary leak rates after cholecystectomy and intraoperative cholangiogram in surgical residency.
Robert R Shawhan (2015)
Learning curve for pancreatoduodenectomy: can it be generalized?
Hyeong Min Park (2020)
Trainee performance in radical gastrectomy and its effect on outcomes
M. Navidi (2020)
Clinical Impact of Structured Follow-up After Pancreatic Surgery
Christine Tjaden (2016)
Training in the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons during 225 consecutive pancreaticoduodenectomies
Daisuke Hashimoto (2019)
Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality?
Nicholas B Abt (2016)
Extended pancreatic transection for secure pancreatic reconstruction during pancreaticoduodenectomy
Eun-Kyoung Jwa (2017)
Semantic Scholar Logo Some data provided by SemanticScholar