PS5-03: RESIDENT INVOLVEMENT IN MINIMALLY-INVASIVE VS. OPEN SURGICAL PROCEDURES
Susanna W de Geus, MD, PhD, Alaina D Geary, MD, Jacob D Nudel, Sing Chau Ng, Cullen O Carter, David McAneny, Jason F Hall, Donald T Hess, Jennifer F Tseng, Luise I Pernar; Boston Medical Center

Background: Minimally invasive surgery (MIS) has an increasingly prominent role in contemporary surgical therapy for many common diseases. Therefore, surgical residents need to acquire MIS skills. The objective of this study was to evaluate the likelihood of resident involvement in MIS compared to open procedures and how this impacts operative times and outcomes

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2011-2012 was queried for patients who underwent laparoscopic and open ventral hernia repair (VHR), inguinal hernia repair (IHR), splenectomy, or colectomy with or without resident involvement. Multivariable regression analyses were performed to assess the impact of resident involvement on operative time, major complications, length of stay, and readmission.

Results: A total of 3,415 VHR, 5,467 IHR, 678 splenectomy, and 14,781 colectomy cases were included in this study. Resident involvement was similar in MIS compared to open procedures for VHR (61.6% vs. 60.7%; p=0.6440), IHR (50.3% vs. 52.7%; p=0.1702), and splenectomy (74.2% vs. 70.8%; p=0.323). Resident involvement was significantly lower for laparoscopic versus open colectomy (60.5% vs. 65.8%; p<0.001). For minimally-invasive VHR, IHR or splenectomy resident involvement was associated with increased operative time (VHR: AOR, 1.86; p<0.001; IHR: AOR, 3.81; p<0.001; splenectomy: AOR, 2.37; p=0.007) and longer hospital stay (VHR: AOR, 1.15; p=0.014; IHR: AOR, 1.92; p<0.001). However, resident involvement was not predictive for major complications or unplanned readmission. In patients who underwent minimally-invasive colectomy, resident involvement was predictive for unplanned readmission (AOR, 1.31; p=0.002), prolonged operative time (AOR, 1.86; p<0.001), and length of stay (AOR, 1.15; p=0.014) but did not impact the incidence of major complications.

Conclusions: Widespread adoption of MIS approaches to common general surgical diseases demands a corresponding increase in the laparoscopic case volume general surgery residents ought to perform. Our results suggest that residents do have appropriate exposure to MIS procedures. In contrast, the reciprocal drop in open surgical volume due to shifting practice patterns may raise concerns about the open proficiency among future trainees. Although open surgical techniques likely remain essential in a general surgeon’s armamentarium, these finding support a shift toward early specialization for selected fellowships.