title: A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair.
abstract: BACKGROUND
  The purpose of this study was to analyze the effect of residents on patient outcomes in laparoscopic ventral hernia repair (LVHR).We hypothesized that increasing postgraduate year (PGY) level would correlate with better outcomes.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2011 for elective LVHR. Attending only cases were used as the control, and resident cases were stratified into junior (PGY 1-3), chief (4-5), and fellow (6+) cases. Standard statistical tests and multivariate regression controlling for age, body mass index, Charlson comorbidity index, smoking, functional status, and inpatient cases were performed for trainee involvement and PGY level.
  
  
  RESULTS
  There were 6,841 ventral hernia repairs that met inclusion criteria: 2,773 attending and 4,068 resident cases. There were 1,644 junior, 1,983 chief, and 441 fellow cases. Patients were similar between the attending and resident groups. The resident group had a higher rate of inpatient cases, general complications, longer operative time, and hospital length of stay. After controlling for confounders in multivariate analysis, only operative time was significantly different; resident cases were 17.7 min longer (CI 15.0-20.6; p < 0.001). There was no significant difference in the rate of wound or major complications, readmission, reoperation, or mortality between attending and resident cases. Demographics were not significantly different between the PGY level strata. On multivariate regression by PGY level with attending alone as the reference, only operative time was significantly different. Juniors (15.7 min, CI 12.2-19.2), chiefs (18.0 min, CI 14.7-21.3), and fellows (24.9 min, CI 19.1-30.7) had significantly longer cases than attending alone; all p < 0.001.
  
  
  CONCLUSIONS
  Trainee involvement during LVHR does not change the clinical outcomes for patients as compared to those performed by an attending only. Operative time is significantly longer with increasing PGY level, perhaps indicating the complexity of the operation or increasing trainee involvement as primary surgeon. However, patient care does not suffer, affirming the current surgical training curriculum is appropriate.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA, samuel.ross@carolinashealthcare.org.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Ross
authors.forename: Bindhu
authors.initials: B
authors.lastname: Oommen
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Walters
authors.forename: John M
authors.initials: JM
authors.lastname: Green
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: Vedra A
authors.initials: VA
authors.lastname: Augenstein
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000193:education*; D059685:Herniorrhaphy / Q000193:education / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D058996:Quality Improvement; D016896:Treatment Outcome