78 LAPAROSCOPIC APPENDECTOMY OUTCOMES FOR SENIOR PEDIATRIC SURGERY TRAINEES OPERATING WITHOUT SUPERVISION ARE SIMILAR TO THE OUTCOMES OF EXPERIENCED PEDIATRIC SURGEONS
Heron Baumgarten, Erin Brown, Katie Russell, Pablo Laje
Children's Hospital of Philadelphia, Philadelphia, USA

Abstract

Aim of the Study: Pediatric surgery trainees at our program are allowed to perform unsupervised laparoscopic appendectomies during their last year of training to promote independent patient management and operative decision-making skills. In this study we reviewed the outcomes of laparoscopic appendectomies done by senior trainees without supervision and compared them to the outcomes of experience pediatric surgeons.

Methods: We reviewed 500 laparoscopic appendectomies performed without supervision by the last 10 consecutive senior pediatric surgery trainees (first 50 cases of each trainee); 2011-2017.  We compared those outcomes with the last 200 laparoscopic appendectomies performed by eight experienced pediatric surgeons (last 25 of each surgeon). Primary outcomes: operative time, intraoperative and postoperative complications, length of stay, re-admissions, re-operations.

Main Results: Median age in the “trainees” and the “surgeons” groups was 11 (2 - 22) and 12 (2 - 20) years (p: 0.351). The proportion of perforated appendicitis was 98/500 (19.6%) and 42/200 (21%) in the trainees and surgeons groups, respectively (p: 0.753). Mean operative time was 41 (SD 14.5) minutes in the trainees group vs. 39 (SD 16.1) minutes in the surgeons group (p: 0.052). Minor intraoperative complications occurred in 3/500 cases in the trainees group vs. 1/200 in the surgeons group (p: 0.691). There were no major complications in either group. Postoperative abscesses requiring percutaneous intervention developed in 6/500 and 5/200 cases in the trainees and surgeons groups, respectively (p: 0.36). Mean (SD) length of stay was 2.05 (2.4) and 2.3 (2.9) in the trainees and surgeons groups, respectively (p: 0.253). There were 13/500 vs. 5/200 readmissions (p: 0.92), and 1/500 vs. 1/200 reoperations in the trainees and surgeons groups, respectively (p: 0.91).

Conclusion: Allowing senior pediatric surgery trainees to perform laparoscopic appendectomies without supervision is a safe way to stimulate confidence and autonomy without compromising patient quality of care.


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