A study of the impact of resident participation on the results of surgery for cholecystitis
Kurtz, L.M.; Wise, L.
Surgery 86(4): 530-535
1979
ISSN/ISBN: 0039-6060 PMID: 483162 Document Number: 148124
The hospitalizations of 330 consecutive patients operated on for cholecystitis and cholelithiasis were evaluated retrospectively for the impact of resident participation on the outcome of surgery. Cases were classified according to whether surgery was performed by attendings with residents serving as 1st assistants (group 1.sbd.90 patients); by residents with attendings serving as 1st assistants (group 2.sbd.199 patients); or by residents alone with attendings serving as consultants (group 3.sbd.41 patients). Analysis of general patient characteristics and operative management revealed: a higher incidence of acute biliary tract disease in group 3 (54%) than in groups 1 (29%) and 2 (23%) (P < 0.01); a more frequent performance of cystic duct cholangiograms in group 3 (54%) than in groups 1 (23%) and 2 (30%) (P < 0.01); a greater incidence of diabetes in group 1 (12%) than in groups 2 (4%) and 3 (2%) (P < 0.01); and a lower mean age in group 3 (43.3 yr) (P < 0.05). No other significant differences were demonstrated. Two deaths occurred in high-risk group 2 patients following common duct exploration for complicated cholelithiasis. The mortality rate for the total series was 0.6%; it was 3.4% for patients 65 yr of age or older. The incidence of significant nonfatal postoperative morbidity was similar throughout the series: group 1.sbd.16.7%; group 2.sbd.15.2% and group 3.sbd.14.6%. The duration of the in-hospital convalescence period was similar for all 3 groups. Overall analysis of the data suggests that performance of surgery by the resident staff with appropriate supervision does not have an adverse effect on the outcome of that surgery.