Increased Surgical Risks in Hepatobiliary and Pancreatic Surgery Following the Shift to Single-Surgeon Practice...

The availability of assistive surgical personnel plays a crucial role in optimizing patient outcomes and operational efficiency. In March 2024, South Korea experienced a significant shift in surgical practices due to a nationwide trainee strike, necessitating single-surgeon procedures in most hospitals. This study examines the impact of this transition on surgical outcomes.

This study used prospectively collected surgical records at CHA Bundang Medical Center. Patients who underwent hepatobiliary and pancreatic surgery between August 2023 and September 2024 were divided into two groups consecutively (Group 1: August 2023 to February 2024, surgeries performed with an assistant doctor vs. Group 2: March 2024 to September 2024, solo-surgeon surgeries). After propensity score matching, surgical outcomes and prognostic factors were compared.

A total of 995 patients were included (499 in the assistant surgeon group, 496 in the solo surgeon group). After propensity score matching, 388 matched pairs were analyzed. While overall complication rates did not significantly differ between groups (3.6% vs. 6.7%, P = 0.074), major complications were significantly more frequent in the solo-surgeon group (1.8% vs. 4.6%, P = 0.042). Hospital length of stay and operative time were comparable between groups. Subgroup analysis suggested a trend toward increased major complications in open surgery and elderly patients, though statistical significance was not reached.

The transition to solo-surgeon practice in gallbladder-centric hepatobiliary and pancreatic surgery may be associated with a higher incidence of major complications, particularly in complex cases. Further studies are needed, but a team-based surgical approach may improve outcomes in select patient populations.