title: Advanced laparoscopic fellowship training decreases conversion rates during laparoscopic cholecystectomy for acute biliary diseases: a retrospective cohort study.
abstract: BACKGROUND
  Acute biliary pathology is a risk factor for conversion to open surgery and increased surgical morbidity during laparoscopic cholecystectomy (LC). The purpose of our study was to examine the impact of an advanced laparoscopic fellowship-trained surgeon on risks of conversion, surgical morbidity, and postoperative complications in this patient population.
  
  
  METHODS
  Of 1382 patients who underwent an LC from January 2008 to August 2011, 592 patients were diagnosed with an acute biliary process and were included in the study. Patients were divided into two groups; those operated on by an advanced laparoscopic fellowship-trained surgeon (N=237), and those operated on by a non-laparoscopic fellowship-trained surgeon (N=355). The primary end-points were conversion rates and surgical morbidity. The secondary end-point was operative time.
  
  
  RESULTS
  Fellowship-trained surgeons were more likely to perform IOC (57%) versus non-fellowship trained surgeons (20%) (p<0.0001). The conversion rate for the fellowship-trained group was significantly lower than for the non-fellowship trained group (1.7% vs 8.5%, p=0.0004). The intraoperative and postoperative complication rates for the fellowship-trained group were not significantly different. The operative time was slightly longer in the non-fellowship trained group compared to the fellowship-trained group (104 min vs 111 min, p=0.04).
  
  
  CONCLUSIONS
  Our data demonstrate that advanced laparoscopic fellowship training decreases conversion rates of laparoscopic cholecystectomy for acute biliary pathology. Moreover, given the lower conversion rates, patients may have experienced shorter hospitalizations.
  
  
  CONCLUSIONS
  Formal advanced laparoscopic fellowship training may decrease length of stay among patients presenting with acute biliary pathology who undergo laparoscopic cholecystectomy.
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA. Electronic address: jsa9004@nyp.org.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Abelson
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors.forename: Cheguevara
authors.initials: C
authors.lastname: Afaneh
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors.forename: Barrie S
authors.initials: BS
authors.lastname: Rich
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dakin
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000193:education* / Q000592:standards; D041881:Cholecystitis, Acute / Q000601:surgery; D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods*; D005257:Fellowships and Scholarships; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009518:New York; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Acute cholecystitis; Advanced laparoscopic fellowship training; Complication; Conversion; Laparoscopic cholecystectomy; Morbidity