Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in California

Citation
Mm. Hutter et al., Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in California, SURGERY, 128(2), 2000, pp. 286-292
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
SURGERY
ISSN journal
0039-6060 → ACNP
Volume
128
Issue
2
Year of publication
2000
Pages
286 - 292
Database
ISI
SICI code
0039-6060(200008)128:2<286:DTPOAS>2.0.ZU;2-G
Abstract
Background Some patients have concerns regarding. the impact of surgical tr ainees on the quality of care that they receive in teaching hospital. No po pulation-based data exist that describe outcomes of surgical procedures in teaching and nonteaching hospitals; however institutional data suggest that teaching hospital provide high-quality care. We hypothesized that the pres ence of a general surgery residency program (GSRP) is associated with super ior outcomes for Pancreatic resection, a complex surgical procedure. Methods. A retrospective, population-based, risk-adjusted analysis of 5696 patients who underwent major pancreatic resection compares the outcomes of patients treated at hospitals with a GSRP (GSRP+) and those hospital withou t a GSRP (GSRP-). Results. GSRP+ hospitals had a lower operative mortality rate (8.3 % vs 11. 0 %; P < .001), a lower percentage of patients discharged to another acute care hospital or skilled nursing facility (6.5% vs 13.0%; P < .001), and a longer length of stay compared with GSRP- hospitals (22.1 +/- 0.4 days vs 1 9.6 +/- 0.3 days; P < .001). The observed difference in hospital mortality rates was not significant after an adjustment was made for patient mix and hospital volume (9.7% vs 10.0%). However outcomes were found in the univers ity teaching hospitals, as compared with the affiliated teaching and the no nteaching hospitals (5.3% [P < .001] vs 11.4% vs 21.0%; risk adjusted, 8.0% [P < .05] vs 10.9% vs 10.0%). Conclusions. The presence of surgical trainees does not have an adverse imp act on the quality of care for One complex procedure, pancreatectomy and is associated with superior operative mortality rate in university teaching h ospitals.