Trends in first assistant in bariatric surgery: a 5 year analysis

Previous literature has demonstrated the training level of the first assistant (FA) in bariatric surgery may influence outcomes with some studies showing a negative association with trainee level assistant. However, there has been little research on the trend of FA type in bariatric surgery. We sought to understand if there has been a change in the training level of FA in bariatric surgery and if there has been a change in 30-day outcomes.

A retrospective review of primary bariatric surgeries, including Roux-en-Y gastric bypass and sleeve gastrectomy performed between 2015-2019 from the MBSAQIP PUF database was performed. Patient cohorts were categorized based on the training level of first assistant (FA). We evaluated the change in FA level and associated 30-day outcomes.

There has been a decrease in attending FA and, an increase in trainee and midlevel provider FA. Resident FA had the largest increase from 17.4 to 19.3%. Attending FA showed the greatest change, decreasing from 21.7 to 17.5%. Attending FA had the best 30-day outcomes and MIS fellow had the highest rates of adverse outcomes. However, there was no notable change in mortality across all FA groups. Within each FA group, outcomes improved.

There has been a significant decrease in attending level FA and there has been a respective increase in trainee level FA. Attending level FA demonstrated the best outcomes and trainee FA had the highest rates of adverse outcomes. However, trainee level FA outcomes have improved over the study period. If trends continue, trainee level FA may approach outcomes like attending level FA. Without the need for attending level FA, this could increase access to care for the bariatric surgery patient and improve the overall value of bariatric surgery.