T. M. Madkhali1, M. Rajaie1, H. Chen1, R. S. Sippel1, D. Elfenbein1 1University Of Wisconsin,Endocrine Surgery,Madison, WI, USA
Introduction: Several studies have examined the association of surgical trainee’s involvement in surgical procedures and patient outcomes. While some studies suggest that involvement of residents is associated with longer operative times and more complications, others are contradictory. Data are limited that compare patient outcomes based on involvement of a fellow – someone who has already completed a surgical residency, compared to involvement of a resident. We sought to compare the influence of residents and fellows participating in thyroid operations and determine if there was any difference in patient outcomes.
Methods: A retrospective study was performed using our endocrine surgery database between July 2010 and Dec 2013. July 1, 2010 was the starting date of the first endocrine surgery fellow at our hospital. Patients who underwent total thyroidectomy, subtotal thyroidectomy, lobectomy with or without lymph node dissection by endocrine surgeons were included. Patients were grouped by whether the first assistant in the operation was a resident or fellow. Outcomes examined included operative time and perioperative complications. Student t-test and chi-square analysis were used for continuous and categorical variable as appropriate.
Results: A total of 798 patients met inclusion criteria: 416 (52%) had a surgical resident assistant and 382 (48%) had a fellow assistant. Fellows were more often involved in complex cases which included completion thyroidectomy and lymph node dissection (70% vs 30%, P = 0.01). Resident or fellow participation were associated with similar numbers of perioperative complications including hypoparathyroidism and nerve injury (P > 0.05). Both operative time and operating room preparation time did not show any significant differences whether the assistant was a resident or fellow (P > 0.05).
Conclusion: Endocrine surgery fellows are more likely to be involved in more complex thyroidectomy cases than general surgery residents. Having a resident or fellow does not seem to be associated with any differences in outcomes for patients. Furthermore, involvement of fellows is not associated with faster operative times.