A propensity score matching analysis: Impact of senior resident versus fellow participation on outcomes of complex surgical oncology |
| |
| Institution: | 1. Department of Surgery, Boston Medical Center, Boston, MA, USA;2. Boston University School of Medicine, Boston, MA, USA;3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA;2. Albany Medical College, Department of Surgery, 50 New Scotland Avenue, Albany, NY, 12208, USA;1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;2. IRCCS Ospedale Policlinico San Martino, Genova, Italy;3. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;4. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany;5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy;7. Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy;8. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy;9. Department of Urology, Medical University of Graz, Graz, Austria;10. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;11. Department of Urology, Weill Cornell Medical College, New York, NY, USA;12. Department of Urology, University of Texas Southwestern, Dallas, TX, USA;13. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan;1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan;2. Department of Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka City, Fukuoka, 820-8505, Japan;3. Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan;4. Department of Surgery, Matsuyama Red Cross Hospital, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan;5. Department of Surgery, Oita Red Cross Hospital, 3-2-37, Chiyo-machi, Oita, Oita, 870-0033, Japan;6. Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan;7. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan;8. Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan;1. Department of Radiology, University Hospital, LMU Munich, Munich, Germany;2. Department of Surgery, University Hospital, LMU Munich, Munich, Germany;3. Department of Pathology, University Hospital, LMU Munich, Munich, Germany;4. Department of Medicine III, University Hospital, LMU Munich, Munich, Germany;1. University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany;2. University Hospital Cologne, Department of Orthopaedics, Cologne, Germany;3. Emergency Department, University Hospital of Nancy, Nancy, France;4. Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA;1. Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada;2. Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada;3. University of Toronto, Toronto, Ontario, Canada;4. Division of Thoracic Surgery/Surgical Oncology, Toronto General Hospital, Toronto, Ontario, Canada;5. Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada |
| |
| Abstract: | BackgroundTeaching hospitals that train both general surgery residents and fellows in complex general surgical oncology have become more common. This study investigates whether participation of a senior resident versus a fellow has an impact on outcomes of patients undergoing complex cancer surgery.MethodsPatients who underwent esophagectomy, gastrectomy, hepatectomy, or pancreatectomy between 2007 and 2012 with assistance from a senior resident (post-graduate years 4–5) or a fellow (post-graduate years 6–8) were identified from the ACS NSQIP. Based on age, sex, body mass index, ASA classification, diagnosis of diabetes mellitus, and smoking status, propensity-scores were created for odds of undergoing the operation assisted by a fellow. Patients were matched 1:1 based on propensity score. Postoperative outcomes including risk of major complication were compared after matching.ResultsIn total, 6934 esophagectomies, 13,152 gastrectomies, 4927 hepatectomies, and 8040 pancreatectomies were performed with assistance of a senior resident or fellow. After matching, overall rates of major complications were equivalent across all four anatomic locations between cases performed with the participation of a senior resident versus a surgical fellow: esophagectomy (37.0%% vs 31.6%, p = 0.10), gastrectomy (22.6% vs 22.3%, p = 0.93), hepatectomy (15.8% v 16.0%, p = 0.91), and pancreatectomy (23.9% vs 25.2%, p = 0.48). Operative time was shorter for gastrectomy (212 vs. 232 min; p = 0.004) involving a resident compared to a fellow, but comparable for esophagectomy (330 vs. 336 min; p = 0.41), hepatectomy (217 vs. 219 min; p = 0.85), and pancreatectomy (320 vs. 330 min; p = 0.43).ConclusionsSenior resident participation in complex cancer operations does not appear to negatively impact operative time or postoperative outcomes. Future research is needed to further assess this domain of surgical practice and education, particularly with regard to case selection and operative complexity. |
| |
| Keywords: | Surgical oncology Surgical education Surgical residency Surgical fellowship |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
