Surgical trainee impact on bariatric surgery safety

Area of Science:

• Bariatric Surgery
• Surgical Education
• Patient Safety

Background:

• Bariatric procedures like Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) have learning curves.
• Surgeon experience impacts outcomes, but trainee effects are less understood.
• Assessing trainee impact on early perioperative safety is crucial.

Purpose of the Study:

• To evaluate the influence of surgical trainees on the early perioperative safety of bariatric surgery.
• To compare outcomes based on the level of trainee involvement (resident vs. fellow).
• To analyze the impact of trainees across different bariatric procedures (RYGB, SG) and approaches (laparoscopic, robotic).

Main Methods:

• Utilized the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
• Included non-revisional laparoscopic and robotic RYGB and SG procedures.
• Employed multivariable logistic and linear regression to compare outcomes based on assistant level.

Main Results:

• Fellow presence correlated with increased complications in laparoscopic RYGB, robotic RYGB, and laparoscopic SG.
• Common complications included urinary tract and superficial surgical site infections.
• Resident participation in laparoscopic SG was linked to higher leak rates, readmissions, re-interventions, and overall complications.
• No trainee impact on outcomes was observed in robotic SG procedures.
• The negative impact of fellows on overall complications was mitigated by operative duration.

Conclusions:

• Fellow training shows higher overall complication rates but not on major safety benchmarks like leaks or re-operations.
• Resident trainees significantly impact sleeve gastrectomy outcomes.
• Trainee involvement in bariatric surgery necessitates careful consideration in educational curricula design.