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Increased Postoperative Morbidity Associated With Prolonged Laparoscopic Colorectal Resections Is Not Increased by Resident Involvement
- Source :
- Diseases of the colon and rectum. 61(5)
- Publication Year :
- 2018
-
Abstract
- BACKGROUND Although longer operative times are associated with increased postoperative morbidity, the influence of surgical residents on this association is unclear. OBJECTIVE The purpose of this study was to evaluate whether morbidity associated with operative times in laparoscopic colorectal surgery is increased by resident training. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted using a national database. PATIENTS Laparoscopic ileocolectomies, partial colectomies, and low anterior resections were identified in the National Surgical Quality Improvement Project (2005-2012). This cohort was stratified by the presence of resident involvement (postgraduate clinical year ≤5) and then divided into tertiles of operative time (low, medium, and high), allowing comparisons of cases by duration with resident involvement with cases of similar length without resident involvement. MAIN OUTCOME MEASURES Postoperative morbidity (infectious and noninfectious), length of hospital stay, and unplanned reoperations were the primary study outcomes. RESULTS A total of 20,785 procedures were identified. In aggregate, prolonged operative time was associated with both infectious (OR = 1.49, p < 0.001 with residents; OR = 1.38, p < 0.001 without residents) and noninfectious complications (OR = 1.51, p < 0.001 with residents; OR = 1.48, p < 0.001 without residents) when compared with short cases without residents. Longer hospital stay was observed both within the highest (additional 1.2 days (p < 0.001) with residents; 1.1 days (p < 0.001) without residents) and middle (additional 0.4 days (p < 0.001) with residents; 0.4 days (p = 0.001) without residents) tertiles of operative time. Within the highest tertile of operative length, there was no statistically significant difference in complication rates between cases with and without resident participation. LIMITATIONS The study was limited by its retrospective design and inability to define the complexity of case and extent of resident involvement. CONCLUSIONS Although longer operative times confer increased postoperative morbidity, there was no significant difference in complication rates within the highest tertile between cases with and without resident participation. Resident involvement does not appear to add to the risk of morbidity associated with longer and more complicated surgeries. See Video Abstract at http://links.lww.com/DCR/A440.
- Subjects :
- Male
medicine.medical_specialty
Colectomies
Operative Time
030230 surgery
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Internal medicine
medicine
Humans
Colectomy
Aged
Retrospective Studies
business.industry
Significant difference
Gastroenterology
Internship and Residency
Retrospective cohort study
General Medicine
Length of Stay
Pennsylvania
Quality Improvement
Colorectal surgery
030220 oncology & carcinogenesis
Cohort
Operative time
National database
Female
Laparoscopy
Clinical Competence
Morbidity
business
Complication
Colorectal Neoplasms
Colorectal Surgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 15300358
- Volume :
- 61
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Diseases of the colon and rectum
- Accession number :
- edsair.doi.dedup.....502da52256b837608e296c01668dc032