title: The influence of residents in the outcome of elective laparoscopic surgery: a prospective study comparing a teaching hospital and a private community hospital in Italy.
abstract: OBJECTIVE
  We compared the outcome of elective laparoscopic cholecystectomy (LC) in a teaching hospital and a private communityhospital to assess the impact of the involvement of residents.
  
  
  METHODS
  The following parameters were studied prospectively in patients who underwent elective LC during the period from September 2014 to February 2016 in a teaching university hospital (group A) and in a private community hospital (group B): age, sex, body mass index (BMI), comorbidities, American Society of Anaesthesiologists (ASA) score, length of surgery from skin incision to skin closure, use of drain, 30-day perioperative morbidity and mortality, and length of postoperative hospital stay.
  
  
  RESULTS
  The group A consisted of 93 elective LC and the group B of 167 elective LC. Operative time was significantly longer in group A. Intraoperative complications were similar and no conversion was necessary in both groups. An increased rate of postoperative complications was observed in group A. All postoperative complications were managed with conservative therapy. No mortality occurred. At logistic regression analysis, the only factor favouring the occurrence of complications was the hospital type.
  
  
  CONCLUSIONS
  Our study shows that elective LC can be performed in a teaching hospital with comparable intraoperative morbidity and increased postoperative complications. The greater rate of morbidity found in the teaching hospital may be due to an increased vigilance linked to the presence of residents and not to the lack of expertise.
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina.
authors.forename: E
authors.initials: E
authors.lastname: Spaziani
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina.
authors.forename: A R
authors.initials: AR
authors.lastname: Di Filippo
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina.
authors.forename: S
authors.initials: S
authors.lastname: Orelli
authors.affiliation: Department of Surgery, Hospital "P. Colombo", Velletri, Rome.
authors.forename: O
authors.initials: O
authors.lastname: Tintisona
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina.
authors.forename: V
authors.initials: V
authors.lastname: Di Girolamo
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina.
authors.forename: M
authors.initials: M
authors.lastname: Spaziani
authors.affiliation: Division of Surgery, "Nuova Itor" Clinic, Roma, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Narilli
authors.affiliation: Department of Surgery, Hospital "P. Colombo", Velletri, Rome.
authors.forename: M
authors.initials: M
authors.lastname: Ottaviani
authors.affiliation: Department of Surgery, Hospital "P. Colombo", Velletri, Rome.
authors.forename: M
authors.initials: M
authors.lastname: Picchio
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010820:Physicians / Q000458:organization & administration; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Laparoscopic cholecystectomy; Laparoscopic surgery; Teaching hospital; Training