Impact of Residents on Safety Outcomes in Laparoscopic Cholecystectomy

New training programs face quality concern by faculty who believe resident involvement in operative management may lead to poorer outcomes. This study aims to understand the impact of resident surgeons on outcomes in a specific common surgical procedure.

We obtained a retrospective review of 1216 laparoscopic cholecystectomy cases between June 2012 and June 2017 at a community teaching hospital. Data reviewed included patient demographics, operative time, length of stay, 30-day outcomes. An initial analysis comparing outcomes with/without resident participation was undertaken. A subset analysis comparing junior (PGY 1-2) and senior (PGY 3-5) groups was also performed.

We found the resident group participated in higher-risk patient (ASA > 3, 47.5% vs 39.8%, p = 0.04 more acute disease (59.8% vs 37.5%, p < 0.0001) and emergent surgery (59.7% vs 37.5%, p < 0.0001). Resident involvement in severe cases was not a significant factor in the odds of morbidity, mortality, conversion rate or length of stay. Resident participation did increase the odds of having longer OR time (OR 12.54, 95% CI 7.74-17.34, p < 0.0001).

Resident participation is associated with increased operative times but not complications. This study confirms resident participation in the operating room in difficult and challenging cases is safe.