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Safety assessment of open appendectomies for complicated acute appendicitis in children: a comparison of trainees and specialists

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Abstract

Purpose

The aim of this study was to compare the outcome of children with complicated acute appendicitis (CAA) who underwent open appendectomy (OA) performed either by trainees under the direct supervision of an SPS, or an SPS.

Methods

Two hundred thirty eight patients with CAA were reviewed operated on either by a junior trainee (JT) or a senior trainee (ST) under the direct supervision of an SPS or by an SPS. The outcome measures were the overall rate of complications, operative time (OT), length of hospital stay (LHS) and 30-day readmission rate.

Results

No statistical differences were observed between the three groups regarding the overall complication rates and 30-day readmission rate. Although, no statistical differences were observed in the mean OT between the three groups, the mean OT for perforated appendicitis (PA) performed by JTs was significantly longer than when performed by SPSs (p 0.012). Furthermore, there was a statistically significant difference between JTs and SPSs in terms of LHS for patients with PA (p 0.028).

Conclusion

This study suggests that no statistical differences were observed between the supervised trainees and SPSs regarding the overall complication rate and 30-readmission rate when they performed OA for GA or PA except of a longer OT and LHS for PA performed by JTs.

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References

  1. Van der Leeuw RM, Lombarts KM, Arah OA, Heinamn MJ (2012) A systematic review of the effects of residency training on patient outcomes. BMC Med 10:65–76

    PubMed  PubMed Central  Google Scholar 

  2. Mellinger JP, Willimas RG, Sanfey H, Fryer PJ, Da Rosa D, George BC, Bohnen JD, Schuller MC, Sandhu G, Minter RM, Gardner AK, Scott DJ (2017) Teaching and assessing operative skills: from theory to practice. Curr Probl Surg 54:44–81

    PubMed  Google Scholar 

  3. Zendehas B, Lillehei CW, George BC, Modi BP (2020) Assessment of operative autonomy and readiness for independent practice among pediatric surgery fellows. J Pediatr Surg 55:117–121

    Google Scholar 

  4. Mizrahi I, Mazeh H, Levy Y, Karavani G, Ghanem M, Armon Y, Vromen A, Eid A, Udassin R (2013) Comparison of pediatric appendectomy outcome between pediatric surgeons and general surgery residents. J Surg Res 180:185–190

    PubMed  Google Scholar 

  5. Graat LJ, Bosma E, Roukema JA, Heisterkamp J (2012) Appendectomy by residents is safe and not associated with a higher incidence of complications. Ann Surg 255:715–719

    PubMed  Google Scholar 

  6. Rise-Townsend S, Hall M, Barnes JM, Rankel SJ (2012) Hospital readmission after management of appendicitis at freestanding childrens hospitals: contemporary trends and financial implications. J Pediatr Surg 47:1170–1176

    Google Scholar 

  7. Botha AJ, Elton C, Moore EE, Sauven P (1995) Laparoscopic appendicectomy: a trainee’s perspective. Ann R Coll Surg Engl 77:259–262

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Wong K, Duncan T, Pearson A (2006) Unsupervised laparoscopic appendectomy by surgical trainee is safe and time effective. Asian J Surg 30:161–166

    Google Scholar 

  9. Bencini L, Bernini M, Martini F, Rossi M, Tommasi C, Miranda E, Sanchez LJ, Naspetti R, Manetti R, Ferrara A, Nesi S, Boffi B, Farsi M, Moretti R (2009) Laparoscopic appendectomy performed by residents and experienced surgeons. JSLS 13:391–397

    PubMed  PubMed Central  Google Scholar 

  10. Kim SY, Hong SG, Roh HR, Park SB, Kim YH, Chae GB (2010) Learning curve for a laparoscopic appendectomy by a surgical trainee. J Korean Soc Coloproctol 26:324–328

    PubMed  PubMed Central  Google Scholar 

  11. Colombo F, Andreani SM, Gravante G, Davies A (2012) Laparoscopic vs. open appendicectomies: results obtained by junior surgeons at a British University Hospital. Eur Rev Med Pharmacol Sci 16:687–690

    CAS  PubMed  Google Scholar 

  12. Emmanuel A, Byrne J, Wilson I, Balfe P (2011) Is laparoscopic appendicectomy a safe procedure for trainees in the peripheral hospital setting? Ir Med J 104:276–278

    CAS  PubMed  Google Scholar 

  13. Suh SG, Sohn HJ, Kim BG, Park JM, Choi YS, Park YK, Lee SE (2016) Single-Incision laparoscopic appendectomy by surgical trainees. Surg Laparosc Endosc Percutan Tech 26:470–472

    PubMed  PubMed Central  Google Scholar 

  14. Barrett JR, Drezdzon MK, Monawer AH, O’ Rourke AP, Scarborough JE (2019) Safety in allowing residents to independently perform appendectomy: a retrospective review. J Am Coll Surg 229:621–625

    PubMed  Google Scholar 

  15. Sai Prasad TR, Chui CH, Jacobsen AS (2006) Laparoscopic appendicectomy in children; a trainee’ perspective. Ann Acad Med Singapore 35:694–697

    CAS  PubMed  Google Scholar 

  16. Lee SL, Yaghoubian A (2010) Comparison of pediatric laparoscopic appendectomy outcomes between teaching and non-teaching hospitals: a multi-institutional study. J Laparoendosc Adv Surg Tech A 20:863–865

    PubMed  Google Scholar 

  17. Nataraja RM, Bandi A, Clarke SA, Haddad MJ (2010) Comparison of intra-abdominal abscess formation following laparoscopic and open appendicectomy in children. J Laparoendosc Adv Surg Tech A 20:391–394

    PubMed  Google Scholar 

  18. Wang X, Zhang W, Yang X, Shao J, Zhou X, Yuan J (2009) Complicated appendi citis in children: is laparoscopic appendectomy appropriate? a comparative study with the open appendectomy-our experience. J Pediatr Surg 44:1924–1927

    PubMed  Google Scholar 

  19. Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441

    CAS  PubMed  Google Scholar 

  20. van den Boom AL, Gorter RR, van Haard PM, Doornebosch PG, Heij HA, Dawson I (2015) The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children. Pediatr Surg Int 31:339–345

    PubMed  Google Scholar 

  21. Willis ZI, Duggan EM, Bucher BT, Pietsch JB, Milovancev M, Wharton W, Gillon J, Lovvorn HN 3rd, O’Neill JA Jr, di Pentima MC, Blakely ML (2016) Effect of a clinical practice guideline for pediatric complicated appendicitis. JAMA Surg 151:e160194

    PubMed  PubMed Central  Google Scholar 

  22. Rogers AP, Zens TJ, Leys CM, Nichol PF, Ostlie DJ (2017) A call for a standirezed definition of perforated appendicitis. J Pediatr Surg 52:89–92

    PubMed  Google Scholar 

  23. Emil S, Gaied F, Lo A, Laberge JM, Puligandla P, Shaw K, Baird R, Bernard C, Blumenkrantz M, Nguyen VH (2012) Gangrenous appendicitis in children: a prospective evaluation of definition, bacteriology, histopathology, and outcomes. J Surg Res 177:123–126

    PubMed  Google Scholar 

  24. Fallon SC, Kim ME, Hallmark CA, Carpenter JL, Eldin KW, Lopez ME, Wesson DE, Brandt ML, Ruben Rodriguez J (2015) Correlating surgical and pathological diagnoses in pediatric appendicitis. J Pediatr Surg 50:638–641

    PubMed  Google Scholar 

  25. Lee SL, Islam SM, Cassidy LD, Abdullah F, Arca MJ (2010) Antibiotics and appendicitis in the population: an american pediatric surgical trial association outcomes and clinical trials committee systematic review. J Pediatr Surg 45:2181–2185

    PubMed  Google Scholar 

  26. Saito JM, Chen LE, Hall BL (2013) Risk-adjusted hospital outcomes for children’s surgery. Pediatrics 132:377–381

    Google Scholar 

  27. Sinha CK, Decker E, Rex D, Mukhtar Z, Murphy F, Nicholls E, Okoye B, Giuliani S (2016) Thirty-day readmissions in pediatric surgery: the first U.K. experience. J Pediatr Surg 51:1877–1880

    CAS  PubMed  Google Scholar 

  28. Shaked A, Calderom I (1991) Durst A (1991) Safety of surgical procedures performed by residents. Arch Surg 126:559–560

    CAS  PubMed  Google Scholar 

  29. Baskett RJF, Buth KJ, Legare JF, Hassan A, Friesen CH, Hirsch GM, Ross DB, Sullivan JA (2002) Is it safe to train residents to perform cardiac surgery? Ann Thorac Surgery 74:1043–1049

    Google Scholar 

  30. Lansdown MR, Gray AJ, Treasure T, Layer GT (2006) Appendicectomy: who performs it, when and how? Ann R Coll Surg Engl 88:530–534

    PubMed  PubMed Central  Google Scholar 

  31. Papandria D, Rhee D, Ortega G, Zhang Y, Gorgy A, Makary MA, Abdullah F (2012) Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. J Surg Educ 69:149–155

    PubMed  Google Scholar 

  32. Suadka A, Nava MS, Serji B, El Malki HO, Moshine ER, Belkouchi A, Benkabbou A (2017) Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: experience of an academic surgical department in a developing country. J Minim Access Surg 13:1131–1134

    Google Scholar 

  33. Massenburg BB, Sanati-Mehrizi P, Jabionka EM, Taub PJ (2016) The impact of residents participation in outpatient plastic surgical procedures. Aesthet Plast Surg 40:584–591

    Google Scholar 

  34. Council Directive 93/104/EC of 23 November 1993 concerning certain aspects of the organization of working time. Official Journal of the European aspects of the organization of working time. Official Journal of the European Union 1993 L307:18–24 (https://europa.eu.int)

  35. Owais AE, Whilson TR, Sethi N, Alddori MI, Whose appendicectomy? (2008) Do laparoscopic appendicectomies impair SHO training? Ann R Coll Surg Engl 90:577–580

    PubMed  PubMed Central  Google Scholar 

  36. Timberlake MD, Mayo HG, Scott L, Weis J, Gardner AK (2017) What do we know about intraoperative teaching? A systematic review. Ann Surg 266:251–259

    PubMed  Google Scholar 

  37. Khuri SF, Najjar SF, Daley J, Krasnicka B, Hossain M, Henderson WAust JB, Bass B, Bishop MJ, Demarkis J, DePalma R, Fabri A, Fink A, Gibbs J, Grover F, Hammermeister K, McDonald G, Neumayer L, Roswell RH, Spencer J, Turnage RH, VA National Surgical Quality Improvement Program (2001) comparison of surgical outcomes between teaching and nonteaching hospital in the department of Veterans Affairs. Ann Surg 234:370–382

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Lee SL, Shekherdimian S, Chiu VY (2010) Comparison of pediatric appendicitis outcomes between teaching and nonteaching hospitals. J Pediatr Surg 45:894–897

    PubMed  Google Scholar 

  39. Raval MV, Dean KJ, Rangel SJ, Minneci PC, Nwomeh BC, Kelleher KJ, Moss RL (2013) Assessing quality in pediatric surgery-the limited role of appendectomy as the optimal target. J Pediatr Surg 48:2313–2319

    PubMed  Google Scholar 

  40. Uecker J, Luftman K, Ali S, Brown C (2013) Comparable operative times with and without surgery resident participation. J Surg Educ 70:696–969

    PubMed  Google Scholar 

  41. Hwang CS, Wichterman KS, Alfrey EJ (2010) The cost of resident education. J Surg Res 163:18–23

    PubMed  Google Scholar 

  42. Puram SV, Kozin ED, Sethi R, Alkire B, Lee DJ, Gray ST, Shrime MG, Cohen M (2015) Impact of residents surgeons on procedure length based on common pediatric laparoscopic cases. Laryngoscope 125:991–997

    PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank all the specialist pediatric surgical staff at the “ATTIKON” University General Hospital, Athens and the P&A Kyriakou Children’s Hospital, Athens for including their patients in this study.

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Authors and Affiliations

  1. Department of Pediatric Surgery, “ATTIKON” University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    George Vaos, Nick Zavras, Anastasia Dimopoulou & Emmanouil Iakomidis

  2. Second Department of Pediatric Surgery, P & A Kyriakou Children’s Hospital, Thivon & Levadias Str, 11527, Athens, Greece

    George Pantalos & Alexander Passalides

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  1. George Vaos
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  2. Nick Zavras
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Correspondence to George Vaos.

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Vaos, G., Zavras, N., Dimopoulou, A. et al. Safety assessment of open appendectomies for complicated acute appendicitis in children: a comparison of trainees and specialists. Pediatr Surg Int 36, 1181–1187 (2020). https://doi.org/10.1007/s00383-020-04713-0

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