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Trainee-led emergency laparotomy operating
H Boyd-Carson1,2,3, B Doleman1,3, S Lockwood2
1Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.
The British Journal of Surgery
|April 27, 2020
Summary
Trainee-led emergency laparotomy surgery shows no increased risk of death or return to theatre. However, trainee operating patterns vary significantly by location and time, with trainees operating more in high-volume centers and at night.
Area of Science:
- Surgical Education
- Patient Outcomes
- Emergency Medicine
Background:
- General surgery trainees must master emergency laparotomy procedures.
- This study examines trainee-led emergency laparotomy patterns and their impact on patient outcomes.
Purpose of the Study:
- To describe trainee operating patterns in emergency laparotomy.
- To associate these patterns with postoperative outcomes such as mortality and reoperation.
Main Methods:
- Analysis of 87,367 emergency laparotomies from the National Emergency Laparotomy Audit (December 2013-November 2017).
- Comparison of outcomes between consultant-led and trainee-led procedures.
- Regression analysis for 90-day mortality and return to theatre, stratified by procedure type.
Main Results:
- No increased 90-day mortality or return to theatre observed when trainees were the senior surgeon.
- Trainees were more likely to operate in high-volume centers and during nighttime hours.
- Significant variation in trainee operating by deanery, hospital size, and time of day was noted.
Conclusions:
- Trainee involvement in emergency laparotomy does not negatively impact patient mortality or reoperation rates.
- Significant geographical and temporal variations exist in trainee-led emergency laparotomies.
- These variations do not appear to influence key postoperative outcomes.
