Does fellow participation in laparoscopic Roux-en-Y gastric bypass affect perioperative outcomes?
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGB) requires specialized training commonly acquired during a fellowship. We hypothesized that fellows affect patient outcomes and this effect varies during training.


METHODS
We included all LRYGB from the 2005 to 2009 American College of Surgeons-National Surgical Quality Improvement Program database. Cases without trainees (attending) were compared to those with trainees of ≥6 years (fellow). Outcomes were pulmonary, infectious, and wound complications and deep venous thrombosis (DVT). Multivariable regression controlled for age, BMI, and comorbidities.


RESULTS
Of the 18,333 LRYGB performed, 4,349 (24%) were fellow cases. Fellow patients had a higher BMI (46.1 vs. 45.7, p < 0.001) and fewer comorbidities. Mortality was 0.2 and 0.1% and overall morbidity was 4.8 and 6.0% for attending and fellow groups, respectively. On adjusted analysis, mortality was similar, but fellow cases had 30% more morbidity (p = 0.001). Specifically, fellows increased the odds of superficial surgical site infections (SSSIs) [odds ratio (OR) = 1.4, p = 0.01], urinary infections (UTIs) (OR = 1.7, p = 0.002), and sepsis (OR = 1.5, p = 0.05). During the first 6 months, fellows increased the odds of DVT (OR = 4.7, p = 0.01), SSIs (OR = 1.5, p = 0.001), UTIs (OR = 1.8, p = 0.004), and sepsis (OR = 1.9, p = 0.008). By the second half of training, fellow cases demonstrated outcomes equivalent to attending cases.


CONCLUSIONS
Involving fellows in LRYGB may increase DVT, SSIs, UTIs, and sepsis, especially early in training. By completion of their training, cases involving fellows exhibited outcomes similar to cases without trainees. This supports both the need for fellowship training in bariatric surgery and the success of training to optimize patient outcomes.
Department of Surgery, Providence Cancer Center, Portland, OR 97213, USA. neil03@gmail.com
Neil H
NH
Bhayani
Aditya
A
Gupta
Ashwin A
AA
Kurian
Christy M
CM
Dunst
Ahmed H
AH
Sharata
Kevin M
KM
Reavis
Lee L
LL
Swanstrom
Valerie J
VJ
Halpin
D002983:Clinical Competence; D005257:Fellowships and Scholarships; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome