Supervised independence in elective inguinal hernia repairs performed by surgical residents is not associated with compromised short clinical outcome or rates of reoperation for recurrence - 06/04/22
, Celsa M. Tonelli b, c, Corinne Bunn b, Sujay Kulshrestha b, Sonya P. Agnew b, Tyler D. Cohn b, Zaid M. Abdelsattar d, Marshall S. Baker b, c, Frederick A. Luchette b, cAbstract |
Background |
We evaluate the association between attending surgeon involvement and clinical outcome in elective inguinal hernia repairs performed by residents.
Methods |
Patients undergoing initial elective unilateral inguinal hernia repair between 2004 and 2019 were identified using the Veterans Administration Surgical Quality Improvement Program Database. The level of attending surgeon involvement was categorized as active (attending scrubbed [AS]) or passive (supervising the resident's performance but not scrubbed [ANS]). AS and ANS herniorrhaphies were 1:1 propensity matched for patient demographics, comorbidities, surgical approach, resident postgraduate level, and year of repair. Rates of complication and recurrence for matched cohorts were compared by standard methods.
Results |
30,784 patients met inclusion criteria. 5136 (17%) repairs were performed without the attending scrubbed. On comparison of matched-cohorts, overall complication rates (1.7% vs 1.2%, p = 0.07) and rates of recurrence (1.9% vs 1.4%, p = 0.041) for patients undergoing herniorrhaphy AS were statistically similar to those performed ANS.
Conclusion |
Supervised independence in elective inguinal hernia repair performed by surgical residents is not associated with inferior clinical outcomes.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Residents training in the VA system continue to be given graduated independence as they gain experience in training. |
• | There has been a noted decline over time in the frequency with which supervised independence in elective inguinal hernia repair is offered to residents. |
• | Inguinal hernia repairs performed by senior residents with only passive help or supervision from an attending have equivalent outcomes to procedures in which the attending physician is scrubbed into the operation, including rate of hernia recurrence requiring reoperation. |
Keywords : Education, Medical, Graduate, Internship and residency, Surgeons, Veterans, Quality improvement, Inguinal hernia
Plan
Vol 223 - N° 3
P. 470-474 - mars 2022 Retour au numéro
Article précédent
- Colectomy for polyps is associated with high risk for complications and low risk for malignancy: Time for endoluminal surgery?
- Elective inguinal hernia repair: Is increased resident autonomy associated with early postoperative clinical outcome?
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?