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Increased Postoperative Morbidity Associated With Prolonged Laparoscopic Colorectal Resections Is Not Increased by Resident Involvement

Kulaylat, Audrey, S., M.D.1; Hollenbeak, Christopher, S., Ph.D.1,2; Stewart, David, B., Sr, M.D.1

Diseases of the Colon & Rectum: May 2018 - Volume 61 - Issue 5 - p 579–585
doi: 10.1097/DCR.0000000000000934
Original Contributions: Benign
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BACKGROUND: Although longer operative times are associated with increased postoperative morbidity, the influence of surgical residents on this association is unclear.

OBJECTIVE: The purpose of this study was to evaluate whether morbidity associated with operative times in laparoscopic colorectal surgery is increased by resident training.

DESIGN: This was a retrospective cohort study.

SETTINGS: The study was conducted using a national database.

PATIENTS: Laparoscopic ileocolectomies, partial colectomies, and low anterior resections were identified in the National Surgical Quality Improvement Project (2005–2012). This cohort was stratified by the presence of resident involvement (postgraduate clinical year ≤5) and then divided into tertiles of operative time (low, medium, and high), allowing comparisons of cases by duration with resident involvement with cases of similar length without resident involvement.

MAIN OUTCOME MEASURES: Postoperative morbidity (infectious and noninfectious), length of hospital stay, and unplanned reoperations were the primary study outcomes.

RESULTS: A total of 20,785 procedures were identified. In aggregate, prolonged operative time was associated with both infectious (OR = 1.49, p < 0.001 with residents; OR = 1.38, p < 0.001 without residents) and noninfectious complications (OR = 1.51, p < 0.001 with residents; OR = 1.48, p < 0.001 without residents) when compared with short cases without residents. Longer hospital stay was observed both within the highest (additional 1.2 days (p < 0.001) with residents; 1.1 days (p < 0.001) without residents) and middle (additional 0.4 days (p < 0.001) with residents; 0.4 days (p = 0.001) without residents) tertiles of operative time. Within the highest tertile of operative length, there was no statistically significant difference in complication rates between cases with and without resident participation.

LIMITATIONS: The study was limited by its retrospective design and inability to define the complexity of case and extent of resident involvement.

CONCLUSIONS: Although longer operative times confer increased postoperative morbidity, there was no significant difference in complication rates within the highest tertile between cases with and without resident participation. Resident involvement does not appear to add to the risk of morbidity associated with longer and more complicated surgeries. See Video Abstract at

1 Department of Surgery, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

2 Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

See editorial on page 527.

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: David B. Stewart, M.D., Pennsylvania State University, College of Medicine, Department of Surgery, 500 University Dr, H137, PO Box 850, Hershey, PA 17033-0850. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons