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Trends in first assistant in bariatric surgery: a 5 year analysis.
Justin Dhyani1, Craig Wood2, Jordan Salvato2
1Department of Bariatric and Foregut Surgery, Geisinger Medical Center, Danville, PA, USA. justindhyani@gmail.com.
Surgical Endoscopy
|July 14, 2025
Summary
Bariatric surgery trends show fewer attending first assistants (FAs) and more trainees. While attending FAs had better outcomes, trainee outcomes improved, potentially increasing access to care.
Area of Science:
- Bariatric Surgery
- Surgical Outcomes
- Healthcare Trends
Background:
- First assistant (FA) training level in bariatric surgery may impact patient outcomes.
- Limited research exists on trends in FA types and their association with outcomes.
Purpose of the Study:
- To analyze changes in the training level of first assistants (FAs) in bariatric surgery.
- To evaluate the association between FA training level and 30-day surgical outcomes.
Main Methods:
- Retrospective review of primary bariatric surgeries (2015-2019) using the MBSAQIP PUF database.
- Categorization of patient cohorts based on the training level of the first assistant (FA).
- Evaluation of trends in FA levels and their correlation with 30-day outcomes.
Main Results:
- A decrease in attending FAs and an increase in trainee and midlevel provider FAs were observed.
- Attending FAs had the best 30-day outcomes; MIS fellows had the highest adverse event rates.
- No significant change in mortality was noted, and outcomes improved within all FA groups.
Conclusions:
- Significant decrease in attending FAs with a corresponding rise in trainee FAs.
- Attending FAs demonstrated superior outcomes, while trainee FAs showed higher adverse event rates.
- Improving trainee FA outcomes suggest potential for increased access to bariatric surgery and enhanced value of care.
