A. Ejaz1, G. Spolverato1, Y. Kim1, C. Wolfgang1, K. Hirose1, M. Weiss1, T. M. Pawlik1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: Resident participation and level of involvement during major hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in major hepatic and pancreatic resections is poorly defined.
Methods: We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006-2012 using the American College of Surgeons National Surgical Quality Improvement Program database. Operations were categorized based on resident participation. Outcomes were analyzed in a propensity score-matched cohort adjusting for nonrandom assignment of resident participation.
Results: Resident participation was found in the majority of cases (n=21,857, 85.7%). Median patient age was 62 years (IQR: 53, 62) and comorbidities were common (ASA Class 3&4: n=17,093, 67.1%). Pancreatic resections (n=16,045, 62.9%) were more common than liver resections. Resident participation was more common in younger patients (OR 1.10, 95%CI 1.02-1.18), females (OR 1.09, 95%CI 1.01-1.16) (both P<0.05). Resident participation resulted in longer mean operative times for both hepatic (9 minutes) and pancreatic (22 minutes) resections (both P<0.01). Need for perioperative transfusion, total hospital length of stay, and reoperation rates were unaffected by resident participation (all P>0.05). After adjusted analysis in the propensity score-matched cohort, resident participation resulted in higher risk of perioperative morbidity (OR 1.35, 95%CI 1.21-1.51; P<0.001) but equivalent 30-day mortality (OR 1.27, 95%CI 0.97-1.67; P=0.08).
Conclusion: Resident participation during hepatic and pancreatic resections results in longer operative times, higher rates of morbidity, but equivalent rates of mortality. As such, resident participation and involvement should be encouraged during these complex cases.