Operative Outcomes and Training Equity in Appendicectomy: Are Core Surgical Trainees Getting a Fair Chance?

Appendicectomy is an important index procedure for core surgical trainees (CSTs). However, there are growing concerns that reduced operative exposure due to service pressures and working time restrictions may be limiting CST experience. This study aimed to assess the extent of CST involvement in appendicectomies at a district general hospital in the United Kingdom and to compare the safety, efficacy, and outcomes of procedures performed across different grades of surgeons.

A retrospective review was conducted of all appendicectomies performed between December 2023 and June 2024. Demographic, perioperative, and postoperative data were extracted from electronic records. Patients undergoing appendicectomy for non-appendicitis indications were excluded. Cases were categorised by the primary operator: consultant, registrar, or CST. Data were analysed using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, New York, United States). Continuous and categorical variables were compared across surgeon grades using appropriate parametric or non-parametric tests. Variables with significant or clinically relevant differences were entered into multivariable logistic regression models adjusting for key confounders, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). A p-value <0.05 was considered statistically significant.  Results: A total of 254 appendicectomies were analysed: 46 (18.1%) consultant-led, 170 (66.9%) registrar-led, and 38 (15.0%) CST-led. Median patient age was 31 years (IQR 29), with no significant difference in gender or American Society of Anesthesiologists (ASA) physical status distribution across groups. Consultants operated on older patients with higher pre-operative C-reactive protein (CRP) levels (p < 0.001), reflecting more complex cases. Case complexity varied significantly by operator grade (p = 0.012). Operative duration, length of stay, complication rate, and readmission rate were similar across all grades (p > 0.05). In adjusted analyses, surgeon grade was not an independent predictor of complications (CST vs consultant: adjusted OR 2.85, 95%CI 0.67-12.00, p > 0.05) or readmissions (CST vs consultant: adjusted OR 1.70, 95%CI 0.34-8.64, p > 0.05).

CSTs performed significantly fewer appendicectomies than registrars yet achieved comparable outcomes when given the opportunity. No differences were found in operative duration, complication, or readmission rates between grades. These findings support increased supervised autonomy and equitable case allocation for CSTs to ensure adequate operative exposure and preparedness for higher surgical training. National evaluation of trainee involvement in index procedures is warranted to optimise training and workforce sustainability.