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The Influence of Surgical Experience on Postoperative Recovery in Fast-Track Bariatric Surgery

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Abstract

Introduction

Short duration of surgery is an important aspect in fast-track protocols. Peroperative training of surgical residents could influence the duration of surgery, possibly affecting patient outcome. This study evaluates the influence of the operator’s level of experience on patient outcome in fast-track bariatric surgery.

Methods

Data was analyzed of all patients who underwent a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between January 2004 and July 2018. Residents were trained according to a stepwise training program. For each operator, learning curves of both procedures were created by dividing the procedures in time-subsequent groups (TSGs). Data was also analyzed by comparing “beginners” with “experienced operators,” with a cut-off point at 100 procedures. Primary outcome measure was duration of surgery. Secondary outcome measures were length of hospital stay (LOS), complications, and readmission rate within 30 days postoperatively.

Results

There were 4901 primary procedures (53.1% LSG) performed by seven surgeons or surgical residents. We found no difference between beginning and experienced operators in complications or readmissions rates. The experience of the operator did not influence LOS (p = 0.201). Comparing each new operator with previous operator(s), the starting point in terms of duration of surgery was shorter, and the learning curve was steeper. The duration of surgery was significantly longer for supervised beginning operators as compared with experienced operators.

Conclusion

Within the stepwise training program for residents, there is a slight increase in duration of surgery in the beginning of the learning curve, without affecting the patient outcome.

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Abbreviations

CI:

Confidence interval

ERABS:

Enhanced recovery after bariatric surgery

LOS:

Length of stay

LRYGB:

Laparoscopic Roux-en-Y gastric bypass

LSG:

Laparoscopic sleeve gastrectomy

OR:

Odds ratio

T2D:

Type 2 diabetes

TSG:

Time-subsequent group

VTE:

Venous thromboembolic event

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Authors and Affiliations

  1. Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM,, Rotterdam, The Netherlands

    M. Leeman, G.H.E.J. Vijgen, J.A. Apers, J.F. Zengerink, M. Dunkelgrun & L.U. Biter

  2. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands

    C. Verhoef

Authors
  1. M. Leeman
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  2. G.H.E.J. Vijgen
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  3. J.A. Apers
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  4. J.F. Zengerink
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  5. C. Verhoef
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  6. M. Dunkelgrun
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  7. L.U. Biter
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Correspondence to M. Leeman.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Leeman, M., Vijgen, G., Apers, J. et al. The Influence of Surgical Experience on Postoperative Recovery in Fast-Track Bariatric Surgery. OBES SURG 30, 1653–1659 (2020). https://doi.org/10.1007/s11695-020-04399-2

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  • DOI: https://doi.org/10.1007/s11695-020-04399-2

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