Outcomes of Resident Versus Fellow Assisted Bariatric Surgery

Patrick E LeMasters, MD, Emily W Shi, MD, Andrew Bates, MD, Edward H Chin, MD, FACS, Daniel M Herron, MD, FACS, William B Inabnet III, MD, Subhash U Kini, MD, Scott Q Nguyen, MD. Icahn School Of Medicine At Mount Sinai.

 NTRODUCTION – Bariatric surgeries performed at our institution consist of Laparoscopic Roux-en-Y Gastric Bypass (LGBP) or Laparoscopic Sleeve Gastrectomy (SG). These are done with either a surgical resident or a minimally invasive fellow as the assistant. The purpose of our study was to compare outcomes of resident or fellow assisted bariatric surgery.

METHODS AND PROCEDURES – Patients undergoing LGBP and SG between January 2008 and December 2012 were retrospectively reviewed. Body Mass Index (BMI), demographics, co-morbidities, operative time, length of stay (LOS), readmissions, complications, and percent excess weight loss at one year (EWL) were compared between the two groups. All analyses were done using SPSS v22.

RESULTS – A total of 282 patients were reviewed. 127 operations were performed by a resident (LGBP 45, SG 82) and 158 by a fellow (RYGB 68, SG 87). Preoperative comorbidities, including diabetes, hypertension, coronary artery disease, asthma, and hyperlipidemia, were similar in both groups. The incidence of obstructive sleep apnea was higher in the fellow group (52 vs 25 p = 0.021). BMI was higher in the fellow group (46.58 vs 44.12 p = 0.003). There was no significant difference between the groups in length of hospital stay (2.13 vs 2.31 days p 0.163), complications (18 vs 17 p = 0.417), or readmission (17 vs 9 0.262). In looking at readmissions after SG (6 vs 3 p = 0.349) and LGBP (11 vs 6 p = 0.67), there was no difference between the groups. Operating room time was significantly shorter in the fellow group for all operations (153 vs 194 minutes p <0.001). When comparing SG (132 vs 162 minutes p = 0.008) and LGBP (180 vs 252 p < 0.001) independently, the fellow group still had shorter operating room time. The percent EWL at one year did not differ between the two groups in both SG (52.42 vs 60.15 p = 0.24) and LGBP (55.22 vs 62.44 p = 0.109).

CONCLUSION – Resident assisted bariatric surgery is safe and does not increase complications when compared to fellow assisted. The operating room time is increased with resident involvement in bariatric surgery.

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