Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example.
OBJECTIVE
Understanding the factors contributing to improved postoperative patient outcomes remains paramount. For complex abdominal operations such as pancreaticoduodenectomy (PD), the influence of provider and hospital volume on surgical outcomes has been described. The impact of resident experience is less well understood.


METHODS
We reviewed perioperative outcomes after PD at a single high-volume center between 2006 and 2012. Resident participation and outcomes were collected in a prospectively maintained database. Resident experience was defined as postgraduate year (PGY) and number of PDs performed.


RESULTS
Forty-three residents and four attending surgeons completed 686 PDs. The overall complication rate was 44 %; PD-specific complications (defined as pancreatic fistula, delayed gastric emptying, intraabdominal abscess, wound infection, and bile leak) occurred in 28 % of patients. The overall complication rates were similar when comparing PGY 4 to PGY 5 residents (55.3 vs. 43.0 %; p > 0.05). On univariate analysis, there was a difference in PD-specific complications seen between a PGY 4 as compared to a PGY 5 resident (44 vs. 27 %, respectively; p = 0.016). However, this was not statistically significant when adjusted for attending surgeon. Logistic regression demonstrated that as residents perform more cases, PD-specific complications decrease (OR = 0.97; p < 0.01). For a resident's first PD case, the predicted probability of a PD-specific complication is 27 %; this rate decreases to 19 % by resident case number 15.


CONCLUSIONS
Complex cases, such as PD, provide unparalleled learning opportunities and remain an important component of surgical training. We highlight the impact of resident involvement in complex abdominal operations, demonstrating for the first time that as residents build experience with PD, patient outcomes improve. This is consistent with volume-outcome relationships for attending physicians and high-volume hospitals. Maximizing resident repetitive exposure to complex procedures benefits both the patient and the trainee.
Department of Surgery at the Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, 1015 Walnut St; Suite 620, Philadelphia, PA, 19107, USA.
Daniel M
DM
Relles
Richard A
RA
Burkhart
Michael J
MJ
Pucci
Jocelyn
J
Sendecki
Renee
R
Tholey
Ross
R
Drueding
Patricia K
PK
Sauter
Eugene P
EP
Kennedy
Jordan M
JM
Winter
Harish
H
Lavu
Charles J
CJ
Yeo
D018784:Abdominal Abscess / Q000209:etiology; D057868:Anastomotic Leak / Q000209:etiology; D002983:Clinical Competence; D004522:Educational Status; D005257:Fellowships and Scholarships; D005746:Gastric Emptying; D061847:Hospitals, High-Volume; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010359:Patient Readmission; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome