Complications and Readmissions Associated with First Assistant Training Level Following Elective Bariatric Surgery
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ORIGINAL ARTICLE
Complications and Readmissions Associated with First Assistant Training Level Following Elective Bariatric Surgery Tarik K. Yuce 1,2 & Amy Holmstrom 2 & Nathaniel J. Soper 2 & Alexander P. Nagle 2 & Eric S. Hungness 2 & Ryan P. Merkow 1,2 & Ezra N. Teitelbaum 2 Received: 9 June 2020 / Accepted: 3 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Little is known regarding the variation in training level and potential clinical impact of the first assistant in bariatric surgery. We describe the postoperative 30-day complications and readmissions following elective bariatric procedures by training level of the first assistant. Methods The ACS-MBSAQIP database was queried to identify patients who underwent elective sleeve gastrectomy, Roux-EnY gastric bypass, duodenal switch, band placement, and revision from 2015 to 2016. Patients were divided into cohorts based on training level of the first assistant (attending, fellow, resident, physician assistant/nurse practitioner, none). Outcomes included 30-day death or serious morbidity (DSM) and readmission. Multivariable logistic regression models, adjusting for patient and procedure characteristics, were estimated to examine differences in outcomes by first assistant training level. Results Of 410,535 procedures performed between 2015 and 2016, the training level of the first assistant included 21.3% attending, 8.7% fellow, 16.5% resident, 37.6% PA/NP, and 15.9% none. Operative time was significantly longer in the fellow and resident first assistant cohorts when compared with all other cohorts. Overall rates of 30-day DSM were low, ranging from 3.2 to 3.8%, while 30-day readmission rates ranged from 5.1 to 5.9%. Following adjustment for patient characteristics and type of procedure, first assistant training level had no significant impact on DSM or readmission. Conclusions Variation in training level of the first assist during bariatric surgery had no influence on DSM or readmissions. This provides reassurance that the inclusion of a wide range of first assistants in bariatric procedures does not negatively impact patient outcomes. Keywords Bariatric surgery . Outcomes . First assistant
Introduction Bariatric operations are the most effective and durable treatment for obesity and associated comorbidities, including diabetes, hypertension, and sleep apnea.1,2 The number of bariatric procedures performed annual within the USA continues to 3 increase. While these procedures have been shown to have This work was presented at the 2020 Digestive Disease Week Meeting * Ezra N. Teitelbaum [email protected] 1
Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
2
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
low rates of mortality and complications, there is an inherent risk associated with operating on morbidly obese patients with multiple comorbidities.4,5 As a result, the eva
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