Do patients outcomes suffer when surgical fellows are involved in hepatic resection?

Neil H. Bhayani, Osama H. Hamed, Aditya Gupta, Gail Ortenzi, Jussuf T. Kaifi, Eric T. Kimchi, Kevin F. Staveley-O'Carroll, Niraj J. Gusani

Research output: Contribution to journalArticle

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Abstract

Introduction Hepatectomy is an advanced technique learned during surgical fellowship. Outcomes have not been described for hepatectomies involving fellows. Methods We analyzed hepatectomies from the 2005-2011 National Surgical Quality Improvement Program database. We compared cases with a fellow (FELLOW group) and those without a fellow (ATTENDING group). Results FELLOW cases (n = 1,562; 54%) included more major hepatectomies and more metastasectomies (P <.002). Mortality was 3.2% versus 2.7% (P =.5) and morbidity was 30.7% vs 26.2% (P =.008) for FELLOW versus ATTENDING cases. On multivariate analysis, mortality was similar, but morbidity was greater in FELLOW cases (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02-1.4; P =.03), with increased superficial surgical site infections (OR, 1.72; 95% CI, 1.2-2.4; P =.001). There were no differences in rates of sepsis, cardiac, pulmonary, or thromboembolic complications. Compared with ATTENDING cases, FELLOW cases during the first half of training, carried greater morbidity (OR, 1.43; 95% CI, 1.1-1.8; P =.006); however, this difference disappears by the second half of the academic year. Conclusion Hepatectomy involving a fellow may be associated with an increased risk of surgical site infections. FELLOW cases were more complex. Mortality, cardiac, pulmonary, and other serious morbidities were similar. Despite slightly greater rates of surgical site infections, training in hepatic surgery maintains excellent patient outcomes.

Original languageEnglish (US)
Pages (from-to)1024-1030
Number of pages7
JournalSurgery (United States)
Volume154
Issue number5
DOIs
StatePublished - Nov 1 2013

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Hepatectomy
Surgical Wound Infection
Liver
Morbidity
Odds Ratio
Confidence Intervals
Mortality
Metastasectomy
Lung
Quality Improvement
Sepsis
Multivariate Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Bhayani, N. H., Hamed, O. H., Gupta, A., Ortenzi, G., Kaifi, J. T., Kimchi, E. T., ... Gusani, N. J. (2013). Do patients outcomes suffer when surgical fellows are involved in hepatic resection? Surgery (United States), 154(5), 1024-1030. https://doi.org/10.1016/j.surg.2013.05.024
Bhayani, Neil H. ; Hamed, Osama H. ; Gupta, Aditya ; Ortenzi, Gail ; Kaifi, Jussuf T. ; Kimchi, Eric T. ; Staveley-O'Carroll, Kevin F. ; Gusani, Niraj J. / Do patients outcomes suffer when surgical fellows are involved in hepatic resection?. In: Surgery (United States). 2013 ; Vol. 154, No. 5. pp. 1024-1030.
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title = "Do patients outcomes suffer when surgical fellows are involved in hepatic resection?",
abstract = "Introduction Hepatectomy is an advanced technique learned during surgical fellowship. Outcomes have not been described for hepatectomies involving fellows. Methods We analyzed hepatectomies from the 2005-2011 National Surgical Quality Improvement Program database. We compared cases with a fellow (FELLOW group) and those without a fellow (ATTENDING group). Results FELLOW cases (n = 1,562; 54{\%}) included more major hepatectomies and more metastasectomies (P <.002). Mortality was 3.2{\%} versus 2.7{\%} (P =.5) and morbidity was 30.7{\%} vs 26.2{\%} (P =.008) for FELLOW versus ATTENDING cases. On multivariate analysis, mortality was similar, but morbidity was greater in FELLOW cases (odds ratio [OR], 1.21; 95{\%} confidence interval [CI], 1.02-1.4; P =.03), with increased superficial surgical site infections (OR, 1.72; 95{\%} CI, 1.2-2.4; P =.001). There were no differences in rates of sepsis, cardiac, pulmonary, or thromboembolic complications. Compared with ATTENDING cases, FELLOW cases during the first half of training, carried greater morbidity (OR, 1.43; 95{\%} CI, 1.1-1.8; P =.006); however, this difference disappears by the second half of the academic year. Conclusion Hepatectomy involving a fellow may be associated with an increased risk of surgical site infections. FELLOW cases were more complex. Mortality, cardiac, pulmonary, and other serious morbidities were similar. Despite slightly greater rates of surgical site infections, training in hepatic surgery maintains excellent patient outcomes.",
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Bhayani, NH, Hamed, OH, Gupta, A, Ortenzi, G, Kaifi, JT, Kimchi, ET, Staveley-O'Carroll, KF & Gusani, NJ 2013, 'Do patients outcomes suffer when surgical fellows are involved in hepatic resection?', Surgery (United States), vol. 154, no. 5, pp. 1024-1030. https://doi.org/10.1016/j.surg.2013.05.024

Do patients outcomes suffer when surgical fellows are involved in hepatic resection? / Bhayani, Neil H.; Hamed, Osama H.; Gupta, Aditya; Ortenzi, Gail; Kaifi, Jussuf T.; Kimchi, Eric T.; Staveley-O'Carroll, Kevin F.; Gusani, Niraj J.

In: Surgery (United States), Vol. 154, No. 5, 01.11.2013, p. 1024-1030.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Do patients outcomes suffer when surgical fellows are involved in hepatic resection?

AU - Bhayani, Neil H.

AU - Hamed, Osama H.

AU - Gupta, Aditya

AU - Ortenzi, Gail

AU - Kaifi, Jussuf T.

AU - Kimchi, Eric T.

AU - Staveley-O'Carroll, Kevin F.

AU - Gusani, Niraj J.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Introduction Hepatectomy is an advanced technique learned during surgical fellowship. Outcomes have not been described for hepatectomies involving fellows. Methods We analyzed hepatectomies from the 2005-2011 National Surgical Quality Improvement Program database. We compared cases with a fellow (FELLOW group) and those without a fellow (ATTENDING group). Results FELLOW cases (n = 1,562; 54%) included more major hepatectomies and more metastasectomies (P <.002). Mortality was 3.2% versus 2.7% (P =.5) and morbidity was 30.7% vs 26.2% (P =.008) for FELLOW versus ATTENDING cases. On multivariate analysis, mortality was similar, but morbidity was greater in FELLOW cases (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02-1.4; P =.03), with increased superficial surgical site infections (OR, 1.72; 95% CI, 1.2-2.4; P =.001). There were no differences in rates of sepsis, cardiac, pulmonary, or thromboembolic complications. Compared with ATTENDING cases, FELLOW cases during the first half of training, carried greater morbidity (OR, 1.43; 95% CI, 1.1-1.8; P =.006); however, this difference disappears by the second half of the academic year. Conclusion Hepatectomy involving a fellow may be associated with an increased risk of surgical site infections. FELLOW cases were more complex. Mortality, cardiac, pulmonary, and other serious morbidities were similar. Despite slightly greater rates of surgical site infections, training in hepatic surgery maintains excellent patient outcomes.

AB - Introduction Hepatectomy is an advanced technique learned during surgical fellowship. Outcomes have not been described for hepatectomies involving fellows. Methods We analyzed hepatectomies from the 2005-2011 National Surgical Quality Improvement Program database. We compared cases with a fellow (FELLOW group) and those without a fellow (ATTENDING group). Results FELLOW cases (n = 1,562; 54%) included more major hepatectomies and more metastasectomies (P <.002). Mortality was 3.2% versus 2.7% (P =.5) and morbidity was 30.7% vs 26.2% (P =.008) for FELLOW versus ATTENDING cases. On multivariate analysis, mortality was similar, but morbidity was greater in FELLOW cases (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02-1.4; P =.03), with increased superficial surgical site infections (OR, 1.72; 95% CI, 1.2-2.4; P =.001). There were no differences in rates of sepsis, cardiac, pulmonary, or thromboembolic complications. Compared with ATTENDING cases, FELLOW cases during the first half of training, carried greater morbidity (OR, 1.43; 95% CI, 1.1-1.8; P =.006); however, this difference disappears by the second half of the academic year. Conclusion Hepatectomy involving a fellow may be associated with an increased risk of surgical site infections. FELLOW cases were more complex. Mortality, cardiac, pulmonary, and other serious morbidities were similar. Despite slightly greater rates of surgical site infections, training in hepatic surgery maintains excellent patient outcomes.

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Bhayani NH, Hamed OH, Gupta A, Ortenzi G, Kaifi JT, Kimchi ET et al. Do patients outcomes suffer when surgical fellows are involved in hepatic resection? Surgery (United States). 2013 Nov 1;154(5):1024-1030. https://doi.org/10.1016/j.surg.2013.05.024