title: Outcomes associated with resident involvement in laparoscopic colorectal surgery suggest a need for earlier and more intensive resident training.
abstract: OBJECTIVE
  The aim of this study is to determine if resident involvement in a large cohort of laparoscopic colorectal surgery (LCS) cases negatively impacts outcomes and ultimately increases costs.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent LCS between 2005 and 2010. Patients were classified into two groups: postgraduate year (PGY; resident involvement) or Attending Only. A subgroup analysis was then conducted among the individual PGY levels (1-2, 3-5, ≥6) and Attending Only group.
  
  
  RESULTS
  A total of 4,836 patients were included in the PGY group and 2,418 in the Attending Only group. Mean operative time (163.9 ± 66.7 vs. 140.7 ± 67.2 minutes, P < .001) and length of hospital stay (5.8 ± 5.4 vs. 5.6 ± 5.4 days, P = .015) were significantly longer in the PGY group. Surgical and nonsurgical complications and overall morbidity and mortality rates were similar between the two groups. Each individual PGY group was associated with longer operative time (P < .001), and PGY ≥ 6 was associated with an increased length of stay (P < .001).
  
  
  CONCLUSIONS
  Although resident participation in LCS does not affect overall mortality or morbidity, it may negatively impact hospital costs through increased operative time and length of hospital stay. Early and intensive laparoscopy training may be necessary for improving residents' laparoscopy skills before their involvement in LCS.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. Electronic address: gorgune@ccf.org.
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Cigdem
authors.initials: C
authors.lastname: Benlice
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Corrao
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Jeff
authors.initials: J
authors.lastname: Hammel
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Ozgen
authors.initials: O
authors.lastname: Isik
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Tracy
authors.initials: T
authors.lastname: Hull
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003107:Colorectal Surgery / Q000191:economics / Q000193:education* / Q000401:mortality; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D010535:Laparoscopy / Q000191:economics / Q000193:education* / Q000401:mortality; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data; D014481:United States