Multicenter retrospective cohort Italian study on elective laparoscopic cholecystectomy performed by the surgical residents

Angelo Iossa; Alessandra Micalizzi; Mary Giuffrè; Maria Chiara Ciccioriccio; Pietro Termine; Francesco De Angelis; Cristian Eugeniu Boru; Giuseppe Di Buono; Antonio Salzano; Matteo Chiozza; Carlotta Agostini; Vania Silvestri; Antonino Agrusa; Gabriele Anania; Umberto Bracale; Francesco Coratti; Giuseppe Cavallaro; Francesco Corcione; Mario Morino; Gianfranco Silecchia

doi:10.1007/s00423-022-02738-8

Multicenter retrospective cohort Italian study on elective laparoscopic cholecystectomy performed by the surgical residents

Langenbecks Arch Surg. 2022 Dec 29;408(1):3. doi: 10.1007/s00423-022-02738-8.

Authors

Angelo Iossa¹, Alessandra Micalizzi², Mary Giuffrè², Maria Chiara Ciccioriccio², Pietro Termine², Francesco De Angelis², Cristian Eugeniu Boru², Giuseppe Di Buono³, Antonio Salzano⁴, Matteo Chiozza⁵, Carlotta Agostini⁶, Vania Silvestri⁷, Antonino Agrusa³, Gabriele Anania⁵, Umberto Bracale⁷, Francesco Coratti⁶, Giuseppe Cavallaro⁸, Francesco Corcione⁷, Mario Morino⁴, Gianfranco Silecchia⁹

Affiliations

¹ Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome-Polo Pontino, ICOT Hospital, 'La Sapienza, Latina, Italy. angelo.iossa@uniroma1.it.
² Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome-Polo Pontino, ICOT Hospital, 'La Sapienza, Latina, Italy.
³ Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
⁴ Department of Surgical Sciences, University of Turin, Citta della Salute e della Scienza Hospital, Turin, Italy.
⁵ Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy.
⁶ Department of Digestive Surgery, Careggi University Hospital, Florence, Italy.
⁷ Department of Gastroenterology, Endocrinology and Surgical Endoscopy, University Hospital Federico II of Naples, Naples, Italy.
⁸ Department of Surgery 'P. Valdoni', Head-General Surgery Unit, University of Rome, ICOT Hospital, La Sapienza', Latina, Italy.
⁹ Department of Medical-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.

PMID: 36577814
DOI: 10.1007/s00423-022-02738-8

Abstract

Purpose: This retrospective multicenter cohort study aimed to evaluate the clinical outcomes (mortality rate, operative time, complications) of elective laparoscopic cholecystectomy (LC) when performed by a surgical resident in comparison to experienced consultant in the backdrop of Italian academic centers.

Methods: Retrospective review of all patients undergoing elective LC between January 2016 and January 2022 at six teaching hospitals across Italy was performed. Cases were identified using the Current Procedural Terminology (CPT) code 5123 (LC without cholangiogram). All cases of emergency surgery, ASA score > 3, or when cholecystectomy was performed with another surgical procedure, were excluded. All suitable cases were divided into 2 groups based on primary surgeon: consultant or senior resident. Main outcome was complication rates (intraoperative and peri/postoperative); secondary outcomes included operative time, the length of stay, and the rate of conversion to open.

Results: A total of 2331 cases (1425 females) were included, of which, consultants performed 1683 LCs (72%), while the residents performed 648 (28%) surgeries. The groups were statistically comparable regarding demographics, history of previous abdominal surgery, operative time, or intraoperative complications. The rate of conversion to open cholecystectomy was 1.42% for consultant and none for resident (p = 0.02). A statistically significant difference was observed between groups regarding the average length of stay (2.2 ± 3 vs 1.6 ± 1.3 days p = 0.03). Similarly, postoperative complications (1.7% vs 0.5%) resulted in statistically significant (p = 0.02) favoring resident group.

Conclusions: Our study demonstrates that in selected patients, senior residents can safely perform LC when supervised by senior staff surgeons.

Keywords: Elective cholecystectomy; Laparoscopic cholecystectomy; Operative time; Resident education; Surgical education.

Publication types

Multicenter Study

MeSH terms

Cholecystectomy / methods
Cholecystectomy, Laparoscopic* / methods
Cohort Studies
Female
Humans
Internship and Residency*
Postoperative Complications / epidemiology
Retrospective Studies