Is resident assistance equivalent to fellows during hepatectomy?

Area of Science:

• Hepatobiliary surgery
• Surgical education
• Patient outcomes

Background:

• Hepatectomy is a complex procedure often involving surgical trainees.
• Assessing the impact of assistant's training level on hepatectomy outcomes is crucial for surgical quality.
• Understanding trainee roles in liver resections informs best practices.

Purpose of the Study:

• To determine if the training level of the assistant surgeon affects outcomes following hepatectomy.
• To compare post-hepatectomy liver failure (PHLF) rates based on assistant experience.
• To analyze the influence of trainee level on operative complexity and outcomes in liver resections.

Main Methods:

• Retrospective review of a prospective ACS-NSQIP database (2013-2016).
• Patients undergoing hepatectomy were divided by assistant: HPB fellow vs. general surgery resident (PGY 4-5).
• Comparison of demographic, perioperative, and 30-day outcomes using statistical analyses, including multivariable regression.

Main Results:

• HPB fellows assisted in more major hepatectomies and hepatobiliary cancer resections.
• Cases with HPB fellows had longer operative times and higher rates of biliary stenting and reconstruction.
• Despite differences in case complexity, post-hepatectomy liver failure (PHLF) rates were not significantly different between groups on multivariable analysis (P=0.173).

Conclusions:

• Assistant's training level (HPB fellow vs. senior resident) did not significantly impact hepatectomy outcomes.
• Both resident and fellow participation in liver resections provide comparable quality of care.
• Surgical trainees at different levels can participate in hepatectomy with similar patient safety profiles.