title: Effect of resident postgraduate year on outcomes after laparoscopic appendectomy for appendicitis in children.
abstract: OBJECTIVE
  The purpose of this study was to determine if the postgraduate level of resident in the operating room correlates with outcomes for pediatric patients undergoing laparoscopic appendectomy.
  
  
  METHODS
  The charts of all children who underwent laparoscopic appendectomy for appendicitis from 2007 to 2011 at a free-standing children's hospital were reviewed. Outcomes of interest were compared between patient groups based on postgraduate level of the junior-most surgeon in the operating room: (1) junior resident (postgraduate year [PGY]-1, -2, and -3); (2) senior resident (PGY-4 or -5); (3) fellow (PGY-6 or -7); or (4) attending surgeon only.
  
  
  RESULTS
  Junior resident (n=327), senior resident (n=129), fellow (n=246), and attending (n=73) groups were similar in terms of age (P=.69), gender distribution (P=.51), race (P=.08), and perforation status (P=.30). Operative time was shorter for senior residents (P=.002), fellows (P<.001), and attending surgeons operating without a resident (P<.001) compared with cases with junior residents. The rate of conversion to an open operation was similar among groups (P=.46). Resident level was not predictive of complications, which occurred in 26 junior resident cases (8.0%; referent), 17 senior resident cases (13.2%; odds ratio [OR] 1.73; P=.11), 33 fellow cases (13.4%; OR 1.71; P=.06), and 8 attending cases (11.0%; OR 1.62; P=.27). Fellow involvement was associated with an increased rate of postoperative percutaneous abscess drainage or re-operation for abscess or bowel obstruction (9.8%; OR 2.31; P=.020).
  
  
  CONCLUSIONS
  Involvement of junior residents in pediatric laparoscopic appendectomy is associated with increased operative time but no higher rate of complications.
authors: Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: Jessica A
authors: JA
authors: Naiditch
authors: Timothy B
authors: TB
authors: Lautz
authors: Mehul V
authors: MV
authors: Raval
authors: Mary Beth
authors: MB
authors: Madonna
authors: Katherine A
authors: KA
authors: Barsness
mesh_terms: D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome