General surgery training without laparoscopic surgery fellows: The impact on residents and patients

• Published in: Surgery 2011-10, Vol.150 (4), p.752-758
• Main Authors: Linn, John G., MD, Hungness, Eric S., MD, Clark, Sara, BS, Nagle, Alexander P., MD, Wang, Edward, MD, PhD, Soper, Nathaniel J., MD
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Bariatric Surgery - education; Bariatric Surgery - statistics & numerical data; Biological and medical sciences; Chicago; Databases, Factual; Digestive System Surgical Procedures - education; Digestive System Surgical Procedures - statistics & numerical data; Fellowships and Scholarships; General aspects; General Surgery - education; General Surgery - statistics & numerical data; Health participants; Healthcare Disparities; Humans; Internship and Residency; Laparoscopy - education; Laparoscopy - statistics & numerical data; Medical sciences; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery; Workload - statistics & numerical data
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2011.07.051

Background To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Methods Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Results Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P < 0.01), esophageal (1 vs 11, P < .01) and bariatric volume (9 vs 36, P < .01). Junior resident laparoscopic volume increased ( P < 0.05). No difference in LOS or complication rate was seen with resident vs fellow assistant. Operative time was greater for gastric bypass with resident assistant (152 ± 51 minutes vs 138 ± 53, P < .05). Conclusion Discontinuing a laparoscopic fellowship significantly increases resident case volume in laparoscopic surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change.