Kevin R Kasten, MD1, Megan Sippey, MD2, Bradley R Davis, MD1, Konstantinos Spaniolas, MD3. 1Carolinas HealthCare System, 2Brody School of Medicine at ECU, 3Stony Brook Medical Center
Introduction: Surgical complications delay adjuvant oncologic therapy, impairing long-term outcomes and worsening survival. We previously demonstrated resident association with increased 30-day overall morbidity following laparoscopic and open colectomy. This study assessed resident post-graduate year (PGY) effect on laparoscopic and open proctectomy for cancer.
Methods and Procedures: Elective open and laparoscopic rectal procedures for cancer from 2005 to 2012 were identified in the ACS-NSQIP database. Demographics, co-morbidities, and 30-day outcomes were analyzed according to resident level (PGY 1-7). We constructed a “resident complication” variable combining surgical site infection, deep space infection, and wound dehiscence to evaluate technical effects of resident involvement. Multivariate logistic regression models with appropriate inputs assessed overall morbidity, surgical site infection (SSI), and “resident complication” in open and laparoscopic cohorts, respectively.
Results: 10,258 rectal cancer patients undergoing open (n=7,180; 70%) or laparoscopic (n=3,078; 30%) proctectomy were analyzed. Absent a resident, attending surgeons performed 1,624 (22.6%) open and 875 (28.4%) laparoscopic procedures. Patients operated on by attendings alone were older with higher rates of cardiac, hepatic, vascular and neurologic comorbidity on univariate analysis. No differences in mortality were observed. Overall morbidity was significantly increased with resident involvement in open (26.5% vs 32.1%, p < 0.001) and laparoscopic proctectomy (17.6% vs 21.4%, p < 0.001). Rates of overall morbidity worsened as PGY level increased above PGY1 in open and PGY2 in lap cases, respectively (linear-to-linear, p < 0.001 for all groups). Similarly, rates of SSI and “resident complication” in open proctectomy worsened with increased PGY level (linear-to-linear, p < 0.001). Interestingly, statistical differences in rates of SSI and “resident complication” disappeared on univariate analysis of laparoscopic proctectomy. On multivariate analysis, resident level was independently associated with SSI in open proctectomy, but not laparoscopic proctectomy (Table 1).
Conclusions: Independent association of resident level with differential morbidity following open and laparoscopic rectal surgery for cancer suggests an impact of resident involvement. Minimally invasive proctectomy appears to mitigate negative infection effects of resident participation. To provide optimal outcomes for oncologic patients in the modern age of surgical training, further evaluation of competency-based observation and teaching platforms are needed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78281
Program Number: P212
Presentation Session: Poster (Non CME)
Presentation Type: Poster
