Do patients' outcomes suffer when surgical fellows are involved in hepatic resection?

Introduction: Hepatectomy is an advanced technique learned during surgical fellowship. Outcomes have not been described for hepatectomies involving fellows.

Methods: We analyzed hepatectomies from the 2005-2011 National Surgical Quality Improvement Program database. We compared cases with a fellow (FELLOW group) and those without a fellow (ATTENDING group).

Results: FELLOW cases (n = 1,562; 54%) included more major hepatectomies and more metastasectomies (P < .002). Mortality was 3.2% versus 2.7% (P = .5) and morbidity was 30.7% vs 26.2% (P = .008) for FELLOW versus ATTENDING cases. On multivariate analysis, mortality was similar, but morbidity was greater in FELLOW cases (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02-1.4; P = .03), with increased superficial surgical site infections (OR, 1.72; 95% CI, 1.2-2.4; P = .001). There were no differences in rates of sepsis, cardiac, pulmonary, or thromboembolic complications. Compared with ATTENDING cases, FELLOW cases during the first half of training, carried greater morbidity (OR, 1.43; 95% CI, 1.1-1.8; P = .006); however, this difference disappears by the second half of the academic year.

Conclusion: Hepatectomy involving a fellow may be associated with an increased risk of surgical site infections. FELLOW cases were more complex. Mortality, cardiac, pulmonary, and other serious morbidities were similar. Despite slightly greater rates of surgical site infections, training in hepatic surgery maintains excellent patient outcomes.