Nathalie Young (Stockholm / SE; Solna / SE), Rebecka Ahl Hulme (Solna / SE; Stockholm / SE), Shahin Mohseni (Stockholm / SE; Örebro / SE), Lewis J Kaplan (Philadelphia, PA / US), Yang Cao (Örebro / SE), Maximilian Peter Forssten (Örebro / SE), Gary Alan Bass (Philadelphia, PA / US; Örebro / SE)
Abstract text (incl. references and figure legends)
Introduction: Graded mentored exposure to pathologies and operative techniques is a cornerstone of surgical training. Appendectomy is one of the first procedures surgical trainees perform independently. We hypothesize that, given the embedded training ethos in surgery coupled with the steep learning curve required to achieve trainer-recognition of independent competency, "real world" clinical outcomes following appendectomy for the treatment of acute appendicitis are operator agnostic.
Material & Methods: This study is a subgroup analysis of the SnapAppy international time-bound prospective observational cohort study, including all consecutive patients aged ≥15 who underwent appendectomy for appendicitis during a three-month period in 2020-2021. Patients were grouped based on operating surgeon experience (trainee only, trainee with direct attending supervision, attending only). Poisson and quantile regression models were used to assess the relationship between surgical experience and postoperative complications or hospital length of stay (hLOS), respectively, while adjusting for confounders.
Results: A total of 4,347 patients from 71 centers in 14 countries were included. Patients operated on by trainees were younger, had lower ASA classifications, and fewer comorbidities compared to those operated on by attendings. Additionally, trainees operated alone on fewer patients with appendiceal perforation (AAST severity grade ≥3: 8.7% vs 15.6%, p<0.001). Regression analyses revealed no association between operator experience and complications (IRR 1.03 95%CI 0.83-1.28 for trainee vs attending; IRR 1.13 95%CI 0.89-1.42 for supervised trainee vs attending) or hLOS.
Conclusion: Clinical outcomes following appendectomy do not differ depending on the experience of the operating surgeon. This may reflect the impact of linking case complexity with operator experience within the context of graduated autonomy throughout surgical training.
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