Laparoscopic cholecystectomy: A prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity

H. Tafazal, P. Spreadborough, D. Zakai, N. Shastri-Hurst, S. Ayaani, Mohammed Hanif*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

INTRODUCTION There is an increasing trend towards day case surgery for uncomplicated gallstone disease. The challenges of maximising training opportunities are well recognised by surgical trainees and the need to demonstrate timely progression of competencies is essential. Laparoscopic cholecystectomy provides the potential for excellent trainee learning opportunities. Our study builds upon previous work by assessing whether measures of outcome are still affected when cases are stratified based on procedural difficulty. MATERIAL AND METHODS A prospective cohort study of all laparoscopic cholecystectomies conducted at a district general hospital between 2009 and 2014, performed under the care of a single consultant. The operative difficulty was determined using the Cuschieri classification. The primary endpoint was duration of operation. Secondary endpoints included length of hospital stay, delayed discharge rate and 30-day morbidity. RESULTS A total of 266 laparoscopic cholecystectomies were performed during the study period. Mean operative time for all consultant- led cases was 52.5 minutes compared with 51.4 minutes for trainees (P = 0.67 unpaired t-test). When cases were stratified for difficulty, consultant-led cases were on average 5 minutes faster. Median duration of hospital stay was equivalent in both groups and there was no statistical difference in re-attendance (12.9% vs. 15.3% P = 0.59) or re-admission rates (3.2% vs. 8.1% P = 0.10) at 30 days. CONCLUSIONS Our study provides evidence that laparoscopic cholecystectomy provides a good training opportunity for surgical trainees without being detrimental to patient outcome. We recommend that, in selected patients, under consultant supervision, laparoscopic cholecystectomy can be performed primarily by the surgical trainee without impacting on patient outcome or theatre scheduling.

Original languageEnglish
Pages (from-to)178-184
Number of pages7
JournalAnnals of the Royal College of Surgeons of England
Volume100
Issue number3
DOIs
StatePublished - 1 Mar 2018
Externally publishedYes

Keywords

  • 30-day morbidity
  • Laparoscopic cholecystectomy
  • Length of stay
  • Operative time
  • Patient care
  • Surgical training

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