The educating enigma: Does training level impact postoperative outcome in bariatric surgery?

Bariatric procedures are complex, and the acceptance of complications by the general public is exceedingly low. Using the database of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, outcomes in bariatric surgery were evaluated to determine the effect of trainees.

The following data on postoperative complications for patients undergoing bariatric surgery in 2015 were collected: surgical site infections, sepsis, urinary tract infection, duration of hospital stay, operative time, renal failure, pulmonary embolus, deep vein thrombosis, pneumonia, and re-operation. These were analyzed against presence and level of trainees, using analysis of variance after normalizing the data.

Of 168,093 procedures, 125,078 were performed without trainees, 14,883 were performed with a fellow, and 28,132 were performed with a resident. Cases without trainees were 25% Roux-en-Y gastric bypass, 59% sleeve gastrectomy, and 16% other. Cases with fellows were 35% Roux-en-Y gastric bypass, 51% sleeve gastrectomy, and 13% other; cases with residents were 27% Roux-en-Y gastric bypass, 59% sleeve gastrectomy, and 15% other. Patient demographics were similar. Average operative time differed between groups as follows: without trainees, 85 minutes; with residents, 105 minutes; and with fellows, 117 minutes (P < .001). Although not dramatically so, infections tended to be a bit more likely with fellows (2% vs 1%; P < .001), and the rate of urinary tract infection and hospital stay tended to be greater with either fellows or residents (1% vs 0%; P < .001; 2.0 days vs 2.1 days vs 1.8 days; P < .001, respectively).

Fellow involvement resulted in the greatest operative times, and the rate of infections, urinary tract infections, and prolonged hospital stay, although statistically greater, were only mildly increased and of questionable clinical importance. These mild increases in postoperative complications may be attributed to prolonged operating room time.