title: Impact of Fellow Versus Resident Assistance on Outcomes Following Pancreatoduodenectomy.
abstract: Participation by surgical trainees in complex procedures is key to their development as future practicing surgeons. The impact of surgical fellows versus general surgery resident assistance on outcomes in pancreatoduodenectomy (PD) has not been well studied. The purpose of this study was to determine differences in patient outcomes based on level of surgical trainee.
  
  
  
  Consecutive cases of PD (n = 254) were reviewed at a single high-volume institution over a 2-year period (July 2013-June 2015). Thirty-day outcomes were monitored through the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) and Quality In-Training Initiative. Patient outcomes were compared between PD assisted by general surgery residents versus hepatopancreatobiliary fellows.
  
  
  
  The hepatopancreatobiliary surgery fellows and general surgery residents participated in 109 and 145 PDs, respectively. The incidence of each individual postoperative complication (renal, infectious, pancreatectomy-specific, and cardiopulmonary), total morbidity, mortality, and failure to rescue were the same between groups.
  
  
  
  Patient operative outcomes were the same between fellow- and resident-assisted PD. These results suggest that hepatopancreatobiliary surgery fellows and general surgery residents should be offered the same opportunities to participate in complex general surgery procedures.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Carr
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Chung
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jester
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Kilbane
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA.
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 541, Indianapolis, IN, 46202, USA. eceppa@iupui.edu.
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
mesh_terms: D000368:Aged; D002983:Clinical Competence; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data; D005257:Fellowships and Scholarships / Q000592:standards*; D005260:Female; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D007396:Internship and Residency / Q000592:standards*; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: ACS-NSQIP; Fellow; Pancreatoduodenectomy; Resident; Surgical education