Our Summary

This study looked at whether surgical trainees (residents) operating independently impacts the outcomes of surgeries. Specifically, it examined a database of patients who had part of their colon removed due to tumors between 2004 and 2019. The team ruled out certain types of surgeries and cases where junior residents were involved. They then divided the surgeries into two groups - where the lead surgeon was physically present and assisting (scrubbed) and where they were not (not scrubbed).

The two groups were similar in terms of patient characteristics, such as age, race, and body mass index. The time it took to perform the surgeries was also similar, regardless of whether the lead surgeon was scrubbed or not.

The researchers then used a statistical model to account for various factors that could influence the results, such as patient age, gender, race, body mass, health status, where the cancer was located, the type of surgery, the year of operation, and the resident’s experience. They found no difference in the risk of complications, severe health problems, or death based on whether the lead surgeon was scrubbed or not.

The conclusion is that surgeries performed by residents with appropriate supervision are just as safe and efficient as those with the lead surgeon present. This suggests that the decision-making of lead surgeons on trainee independence is reliable and that we can design training environments that allow for trainee independence without sacrificing quality, safety, or efficiency.

FAQs

  1. What was the purpose of the study involving surgical trainees and colectomy procedures?
  2. Did the presence of the lead surgeon during the surgery impact the risk of complications, severe health problems, or death?
  3. What conclusions were drawn from the study regarding the efficiency and safety of surgeries performed by residents?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colectomy is to follow their post-operative care instructions carefully. This may include taking prescribed medications, eating a healthy diet, staying hydrated, and avoiding certain activities that could strain the surgical site. It’s important to attend all follow-up appointments with your healthcare provider to monitor your recovery progress and address any concerns.

Suitable For

Patients who are typically recommended colectomy include those with:

  1. Colon cancer or other colorectal tumors
  2. Inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease)
  3. Familial adenomatous polyposis (FAP) or other hereditary colorectal cancer syndromes
  4. Diverticulitis with complications such as perforation or severe bleeding
  5. Severe or recurrent colon polyps
  6. Chronic constipation or colonic inertia
  7. Colonic volvulus
  8. Ischemic colitis

Overall, colectomy may be recommended for various conditions that affect the colon and cannot be effectively managed with medications or other non-surgical treatments. The decision to undergo a colectomy is typically made in consultation with a colorectal surgeon and other members of the healthcare team based on the specific condition, its severity, and the individual patient’s overall health and preferences.

Timeline

  • Before colectomy:
  1. Patient presents with symptoms that may indicate colorectal cancer, such as changes in bowel habits, blood in stool, abdominal pain, or unexplained weight loss.
  2. Patient undergoes various diagnostic tests, such as colonoscopy, CT scans, and blood tests, to confirm the presence of a tumor in the colon.
  3. Patient consults with a surgeon to discuss treatment options, including the possibility of a colectomy to remove part of the colon affected by the tumor.
  4. Patient undergoes preoperative preparations, such as bowel cleansing and dietary restrictions, in preparation for the surgery.
  • After colectomy:
  1. Patient undergoes the colectomy surgery, where part of the colon affected by the tumor is removed.
  2. Patient is closely monitored in the immediate postoperative period for any complications, such as infection, bleeding, or bowel obstruction.
  3. Patient undergoes a recovery period in the hospital, where they are gradually introduced to a liquid diet and monitored for any signs of complications.
  4. Patient may be discharged from the hospital once they are able to tolerate solid food and are able to pass stool normally.
  5. Patient undergoes follow-up appointments with their surgeon to monitor their recovery and discuss any further treatment or surveillance plans.

What to Ask Your Doctor

  • What are the potential risks and complications associated with colectomy surgery?
  • What is the success rate of this surgery for my specific condition?
  • How experienced is the surgical team that will be performing the colectomy?
  • Will a resident or trainee be involved in my surgery, and if so, what level of supervision will they have?
  • What is the expected recovery time and post-operative care plan for this surgery?
  • Are there any alternative treatments or minimally invasive surgical options available for my condition?
  • What can I do to prepare for the surgery and optimize my outcome?
  • What long-term effects or lifestyle changes should I expect after the colectomy?
  • How often will I need follow-up appointments or monitoring after the surgery?
  • Are there any specific dietary or activity restrictions I should be aware of after the colectomy?

Reference

Authors: Tonelli CM, Lorenzo I, Bunn C, Kulshrestha S, Agnew SP, Abdelsattar ZM, Luchette FA, Baker MS. Journal: Surgery. 2022 Mar;171(3):598-606. doi: 10.1016/j.surg.2021.09.036. Epub 2021 Nov 27. PMID: 34844760