Surgical teaching does not increase the risk of intraoperative adverse events.

TitreSurgical teaching does not increase the risk of intraoperative adverse events.
Publication TypeJournal Article
Year of Publication2018
AuthorsPache, B, Grass, F, Fournier, N, Hübner, M, Demartines, N, Hahnloser, D
JournalInternational journal of colorectal disease
Volume33
Issue12
Pagination1715-1722
Date Published12/2018
DOI10.1007/s00384-018-3143-2
ISSN1432-1262
Mots-clésAdverse event, Aged, Blood Loss, Colectomy/education, Complications, Female, Humans, Intraoperative Complications/etiology, Male, Operative Time, Outcomes, Risk Factors, Surgery, Surgical, Teaching, Time Factors
Abstract

INTRODUCTION: Training and teaching are cornerstones in developing surgical skills. The present study aimed to compare intraoperative outcomes of colonic resections among fellows, consultants, and supervised trainees.

METHODS: Data of consecutive colonic resections including demographics, surgical details, and intraoperative outcomes were recorded in a prospectively maintained institutional database. All procedures were standardized and divided in three groups according to the main surgeons experience (fellow or consultant) and whether the procedure was taught. After weighting by inverse treatment probability, intraoperative adverse events including reactive conversion, blood loss, and operating time were compared between these three groups.

RESULTS: Six hundred sixty-four colectomies were analyzed between January 2014 and October 2017. Among them, 289 (43.5%) were taught. After weighted propensity score analysis, there was no difference between the three groups (fellow taken as reference), for intraoperative adverse event rate (odd ratio (OR) consultant 1.448 (IQR 0.728-2.878), p = 0.282; OR teaching 0.689 (IQR 0.295-1.609), p = 0.381), operating time (beta coefficient 0.76 (- 21.91-23.42), p = 0.947; beta coefficient - 10.79 (- 28.34-6.75), p = 0.919), conversion rates (OR 0.748 (0.329-1.515), p = 0.412; OR 1.025 (0.537-1.954), p = 0.940), pre-emptive conversion (OR 1.994 (0.198-20.032), p = 0.552; OR 0.659 (0.145-2.991), p = 0.583), intraoperative blood loss (beta coefficient 21.19 (- 25.87-68.25), p = 0.368; beta coefficient - 12.34 (- 56.13-31.44), p = 0.573), intraoperative transfusion (OR 1.962 (0.813-4.735), p = 0.127; OR 0.670 (0.260-1.727), p = 0.397), and rates of unusual bleeding (OR 1.273 (0.698-2.321), p = 0.422; OR 0.572 (0.290-1.126), p = 0.099). Time to preemptive conversion was shorter when procedures were performed by consultants (beta coefficient - 25.51 (- 47.71 to - 3.31), p = 0.025), while no difference was found for the teaching group (beta coefficient 4.48 (- 30.95-40.62), p = 0.788).

CONCLUSION: Within a standardized teaching environment, colonic resections were safely performed regardless of the surgical setting in the present cohort. Teaching does not increase intraoperative adverse events.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/30143855?dopt=Abstract

WOS ID (UT)

000449774600009

Alternate JournalInt J Colorectal Dis
Citation Key / SERVAL ID9212
Peer reviewRefereed
PubMed ID30143855

                         

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