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The Impact of Trainee Involvement on Outcomes in Metabolic and Bariatric Surgery

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Abstract

Background

The number of bariatric operations performed in the USA rises annually. Trainee exposure to this field is necessary to ensure competency in future surgical generations. However, the safety of trainee involvement of these operations has been called into question.

Objectives

The aim of our study is to describe differences in outcomes between trainees and non-trainees as first assistants (FA) in sleeve gastrectomy (SG).

Setting

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database

Methods

Patients from the MBSAQIP database who underwent primary SG from 2015 to 2020 were identified. Statistical analysis included two-tailed t-tests and χ2-tests to evaluate the impact of trainees (residents and fellows) compared to non-trainees on post-operative morbidity and operative time.

Results

Of the 559,324 cases, 25.8% were performed with trainees as FA. Operative length was 27.9% longer in trainee cases. In the trainee group, there was a higher risk of conversion to open procedure (OR 1.32), readmission (OR 1.19), and specific complications (cardiac arrest, myocardial infarction, progressive renal insufficiency, pulmonary embolism, sepsis, transfusion, intubation, UTI, VTE, ICU admission, and reintervention), though overall rates were < 1% in each group. Non-trainees had a higher rate of septic shock (OR 1.4). No significant difference was seen in all other perioperative outcomes.

Conclusion

Trainee involvement in SG leads to longer operative times without a clinically significant increase in morbidity and mortality. Such findings should be used to counsel patients and shape expectations for surgeons and hospitals. A focused bariatric surgery trainee curriculum may lessen this gap.

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Author information

Authors and Affiliations

  1. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA

    Darian Hoagland & Tara S. Kent

  2. Department of Surgery, Lenox Hill Hospital, New York, USA

    Jaisa Olasky

  3. Department of surgery Mount Auburn Hospital, Harvard Medical School, 355 Waverley Oaks rd, suite 100, Waltham, MA, 02452, USA

    R. Wesley Vosburg

Authors
  1. Darian Hoagland
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  2. Jaisa Olasky
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  3. Tara S. Kent
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  4. R. Wesley Vosburg
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Corresponding author

Correspondence to R. Wesley Vosburg.

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The authors declare no competing interests.

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Key Points

• Trainee involvement in SG leads to longer operative times.

• Trainee involvement is not associated with a clinically significant increase in morbidity and mortality.

• There is a role for focused bariatric surgery curriculum in general surgery resident education.

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Hoagland, D., Olasky, J., Kent, T.S. et al. The Impact of Trainee Involvement on Outcomes in Metabolic and Bariatric Surgery. OBES SURG 33, 3454–3462 (2023). https://doi.org/10.1007/s11695-023-06831-9

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  • DOI: https://doi.org/10.1007/s11695-023-06831-9

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