title: Resident involvement in laparoscopic procedures does not worsen clinical outcomes but may increase operative times and length of hospital stay.
abstract: Surgical procedures have a learning curve regarding the number of cases required for proficiency. Consequently, involvement of less experienced resident surgeons may impact patients and the healthcare system. This study examines basic and advanced laparoscopic procedures performed between 2010 and 2011 and evaluates the resident surgeon participation effect.
  
  
  
  Basic laparoscopic procedures (BL), appendectomy (LA), cholecystectomy (LC), and advanced Nissen fundoplication (LN) were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Cases were identified using Current Procedural Terminology codes. Analyses were performed using IBM SPSS Statistics v.22, α-level = 0.05. Multiple logistic regression was used, accounting for age, race, gender, admission status, wound classification, and ASA classification.
  
  
  
  In total, 71,819 surgeries were reviewed, 66,327 BL (37,636 LC and 28,691 LA) and 5492 LN. Median age was 48 years for LC and 37 years for LA. In sum, 72.2 % of LC and 49.5 % of LA patients were female. LN median age was 59 years, and 67.7 % of patients were female. For BL, resident involvement was not significantly associated with mortality, morbidity, and return to the OR. Readmission was not related to resident involvement in LC. In LA, resident-involved surgeries had increased readmission and longer OR time, but decreased LOS. In LC, resident involvement was associated with longer LOS and OR time. Resident involvement was not a significant factor in the odds of mortality, morbidity, return to OR, or readmission in LN. Surgeries involving residents had increased odds of having longer LOS, and of lengthier surgery time.
  
  
  
  We demonstrate resident involvement is safe and does not result in poorer patient outcomes. Readmissions and LOS were higher in BL, and operative times were longer in all surgeries. Resident operations do appear to have real consequences for patients and may impact the healthcare system financially.
authors.affiliation: The Center for Advanced Surgical Technology, Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jolley
authors.affiliation: The Center for Advanced Surgical Technology, Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lomelin
authors.affiliation: The Center for Advanced Surgical Technology, Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Simorov
authors.affiliation: Hardin Memorial Hospital, 913 N. Dixie Ave., Elizabethtown, KY, 42701, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Tadaki
authors.affiliation: The Center for Advanced Surgical Technology, Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA. doleynik@unmc.edu.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000706:statistics & numerical data; D002983:Clinical Competence; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000706:statistics & numerical data*; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D016896:Treatment Outcome
keywords: Appendectomy; Cholecystectomy; Laparoscopic procedure; Nissen fundoplication; Resident