Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP

Dominic Papandria, Daniel Rhee, Gezzer Ortega, Yiyi Zhang, Amany Gorgy, Martin A Makary, Fizan Abdullah

Research output: Contribution to journalArticle

Abstract

Objective: To examine the effect of surgical trainee involvement on operative time for common surgical procedures. Laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair comprise 17.7% of the total cases sampled in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. These cases are commonly performed by residents at varying levels of surgical training. Study Design: A cross-sectional study was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2005 through 2008 selecting patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair. The primary outcome was operative time and predictive variables were resident involvement and training level. Linear regression analysis was used to compare operative times between cases performed by an attending alone and those assisted by junior (postgraduate year 1-2) or senior (postgraduate year 3-5) trainees, adjusting for patient and operative factors. Results: A total of 115,535 surgical cases were included, with 65,364 (59%) performed with junior or senior surgical residents. Resident participation was associated with higher operative times with no significant differences between the junior and senior cohorts; this effect persisted after controlling for potential confounding factors. Operative time increased by 16.6 minutes (95% confidence interval, 16.2-17.0) for junior residents and also by 16.6 minutes (95% confidence interval, 16.2-16.9) for senior residents. Conclusions: Surgical trainees' participation in common surgical procedures is associated with an increase in total operative time, with no difference between trainee seniority levels. This finding may be significant in assessing the impact of residency training programs on hospital efficiency.

Original languageEnglish (US)
Pages (from-to)149-155
Number of pages7
JournalJournal of Surgical Education
Volume69
Issue number2
DOIs
StatePublished - Mar 2012

Fingerprint

Operative Time
Quality Improvement
trainee
resident
Appendectomy
Inguinal Hernia
Herniorrhaphy
Laparoscopic Cholecystectomy
confidence
Confidence Intervals
participation
Internship and Residency
cross-sectional study
Surgeons
time
training program
Linear Models
regression analysis
Cross-Sectional Studies
Regression Analysis

Keywords

  • ACS-NSQIP
  • inguinal hernia repair
  • laparoscopic appendectomy
  • laparoscopic cholecystectomy
  • National Surgical Quality Improvement Program
  • operative time
  • postgraduate medical education
  • resident
  • surgical training
  • trainee

ASJC Scopus subject areas

  • Surgery
  • Education

Cite this

Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. / Papandria, Dominic; Rhee, Daniel; Ortega, Gezzer; Zhang, Yiyi; Gorgy, Amany; Makary, Martin A; Abdullah, Fizan.

In: Journal of Surgical Education, Vol. 69, No. 2, 03.2012, p. 149-155.

Research output: Contribution to journalArticle

Papandria, Dominic ; Rhee, Daniel ; Ortega, Gezzer ; Zhang, Yiyi ; Gorgy, Amany ; Makary, Martin A ; Abdullah, Fizan. / Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. In: Journal of Surgical Education. 2012 ; Vol. 69, No. 2. pp. 149-155.
@article{d0d370d5cca1487abb216becc856957b,
title = "Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP",
abstract = "Objective: To examine the effect of surgical trainee involvement on operative time for common surgical procedures. Laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair comprise 17.7{\%} of the total cases sampled in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. These cases are commonly performed by residents at varying levels of surgical training. Study Design: A cross-sectional study was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2005 through 2008 selecting patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair. The primary outcome was operative time and predictive variables were resident involvement and training level. Linear regression analysis was used to compare operative times between cases performed by an attending alone and those assisted by junior (postgraduate year 1-2) or senior (postgraduate year 3-5) trainees, adjusting for patient and operative factors. Results: A total of 115,535 surgical cases were included, with 65,364 (59{\%}) performed with junior or senior surgical residents. Resident participation was associated with higher operative times with no significant differences between the junior and senior cohorts; this effect persisted after controlling for potential confounding factors. Operative time increased by 16.6 minutes (95{\%} confidence interval, 16.2-17.0) for junior residents and also by 16.6 minutes (95{\%} confidence interval, 16.2-16.9) for senior residents. Conclusions: Surgical trainees' participation in common surgical procedures is associated with an increase in total operative time, with no difference between trainee seniority levels. This finding may be significant in assessing the impact of residency training programs on hospital efficiency.",
keywords = "ACS-NSQIP, inguinal hernia repair, laparoscopic appendectomy, laparoscopic cholecystectomy, National Surgical Quality Improvement Program, operative time, postgraduate medical education, resident, surgical training, trainee",
author = "Dominic Papandria and Daniel Rhee and Gezzer Ortega and Yiyi Zhang and Amany Gorgy and Makary, {Martin A} and Fizan Abdullah",
year = "2012",
month = "3",
doi = "10.1016/j.jsurg.2011.08.003",
language = "English (US)",
volume = "69",
pages = "149--155",
journal = "Journal of Surgical Education",
issn = "1931-7204",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP

AU - Papandria, Dominic

AU - Rhee, Daniel

AU - Ortega, Gezzer

AU - Zhang, Yiyi

AU - Gorgy, Amany

AU - Makary, Martin A

AU - Abdullah, Fizan

PY - 2012/3

Y1 - 2012/3

N2 - Objective: To examine the effect of surgical trainee involvement on operative time for common surgical procedures. Laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair comprise 17.7% of the total cases sampled in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. These cases are commonly performed by residents at varying levels of surgical training. Study Design: A cross-sectional study was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2005 through 2008 selecting patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair. The primary outcome was operative time and predictive variables were resident involvement and training level. Linear regression analysis was used to compare operative times between cases performed by an attending alone and those assisted by junior (postgraduate year 1-2) or senior (postgraduate year 3-5) trainees, adjusting for patient and operative factors. Results: A total of 115,535 surgical cases were included, with 65,364 (59%) performed with junior or senior surgical residents. Resident participation was associated with higher operative times with no significant differences between the junior and senior cohorts; this effect persisted after controlling for potential confounding factors. Operative time increased by 16.6 minutes (95% confidence interval, 16.2-17.0) for junior residents and also by 16.6 minutes (95% confidence interval, 16.2-16.9) for senior residents. Conclusions: Surgical trainees' participation in common surgical procedures is associated with an increase in total operative time, with no difference between trainee seniority levels. This finding may be significant in assessing the impact of residency training programs on hospital efficiency.

AB - Objective: To examine the effect of surgical trainee involvement on operative time for common surgical procedures. Laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair comprise 17.7% of the total cases sampled in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. These cases are commonly performed by residents at varying levels of surgical training. Study Design: A cross-sectional study was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2005 through 2008 selecting patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair. The primary outcome was operative time and predictive variables were resident involvement and training level. Linear regression analysis was used to compare operative times between cases performed by an attending alone and those assisted by junior (postgraduate year 1-2) or senior (postgraduate year 3-5) trainees, adjusting for patient and operative factors. Results: A total of 115,535 surgical cases were included, with 65,364 (59%) performed with junior or senior surgical residents. Resident participation was associated with higher operative times with no significant differences between the junior and senior cohorts; this effect persisted after controlling for potential confounding factors. Operative time increased by 16.6 minutes (95% confidence interval, 16.2-17.0) for junior residents and also by 16.6 minutes (95% confidence interval, 16.2-16.9) for senior residents. Conclusions: Surgical trainees' participation in common surgical procedures is associated with an increase in total operative time, with no difference between trainee seniority levels. This finding may be significant in assessing the impact of residency training programs on hospital efficiency.

KW - ACS-NSQIP

KW - inguinal hernia repair

KW - laparoscopic appendectomy

KW - laparoscopic cholecystectomy

KW - National Surgical Quality Improvement Program

KW - operative time

KW - postgraduate medical education

KW - resident

KW - surgical training

KW - trainee

UR - http://www.scopus.com/inward/record.url?scp=84863243485&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863243485&partnerID=8YFLogxK

U2 - 10.1016/j.jsurg.2011.08.003

DO - 10.1016/j.jsurg.2011.08.003

M3 - Article

C2 - 22365858

AN - SCOPUS:84863243485

VL - 69

SP - 149

EP - 155

JO - Journal of Surgical Education

JF - Journal of Surgical Education

SN - 1931-7204

IS - 2

ER -