title: The influence of fellowship training on the practice of pancreatoduodenectomy.
abstract: There has been a proliferation of gastrointestinal surgical fellowships; however, little is known regarding their association with surgical volume and management approaches.
  
  
  
  Surveys were distributed to members of GI surgical societies. Responses were evaluated to define relationships between fellowship training and surgical practice with pancreatoduodenectomy (PD).
  
  
  
  Surveys were completed by 889 surgeons, 84.1% of whom had completed fellowship training. Fellowship completion was associated with a primarily HPB or surgical oncology-focused practice (p < 0.001), and greater median annual PD volume (p = 0.030). Transplant and HPB fellowship-trained respondents were more likely to have high-volume (≥20) annual practice (p = 0.005 and 0.029, respectively). Regarding putative fistula mitigation strategies, HPB-trained surgeons were more likely to use stents, biologic sealants, and autologous tissue patches (p = 0.007, <0.001 and 0.001, respectively). Surgical oncology trainees reported greater autologous patch use (p = 0.003). HPB fellowship-trained surgeons were less likely to routinely use intraperitoneal drainage (p = 0.036) but more likely to utilize early (POD ≤ 3) drain amylase values to guide removal (p < 0.001). Finally, HPB fellowship-trained surgeons were more likely to use the Fistula Risk Score in their practice (29 vs. 21%, p = 0.008).
  
  
  
  Fellowship training correlated with significant differences in surgeon experience, operative approach, and use of available fistula mitigation strategies for PD.
authors.affiliation: Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Kennedy
authors.affiliation: Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: McMillan
authors.affiliation: Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sprys
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.affiliation: Department of Surgery, Portland Providence Cancer Institute, Portland, OR, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.affiliation: Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA.
authors.forename: Dhiresh R
authors.initials: DR
authors.lastname: Jeyarajah
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Minter
authors.affiliation: Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: Charles.Vollmer@uphs.upenn.edu.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D005257:Fellowships and Scholarships; D005762:Gastroenterology / Q000193:education*; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000193:education*; D010818:Practice Patterns, Physicians'; D066231:Surgeons / Q000193:education*; D016896:Treatment Outcome; D016526:Workload