Involvement of surgical trainees in surgery for colorectal cancer and their effect on outcome

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Abstract:

Abstract Objective 

Surgical training in the UK is undergoing substantial changes. This study assessed: 1) the training opportunities available to trainees in operations for colorectal cancer, 2) the effect of colorectal specialization on training, and 3) the effect of consultant supervision on anastomotic complications, postoperative stay, operative mortality and 5-year survival. Method 

Unadjusted and adjusted comparisons of outcomes were made for unsupervised trainees, supervised trainees and consultants as the primary surgeon in 7411 operated patients included in the Northern Region Colorectal Cancer Audit between 1998 and 2002. Results 

Surgery was performed in 656 (8.8%) patients by unsupervised trainees and in 1578 (21.3%) patients by supervised trainees. Unsupervised operations reduced from 182 (12.4%) in 1998 to 82 (6.1%) in 2002 (P < 0.001). Consultants with a colorectal specialist interest were more likely than nonspecialists to be present at surgical resections (OR 1.35, 1.12–1.63, P = 0.001) and to provide supervised training (OR 1.34, 1.17–1.53, P < 0.001). Patients operated on by unsupervised trainees were more often high-risk patients, however, consultant presence was not significantly associated with operative mortality (OR 0.83, 0.63–1.09, P = 0.186) or survival (HR 1.02, 0.92–1.13, P = 0.735) in risk-adjusted analysis. Supervised trainees had a case-mix similar to consultants, with shorter length of hospital stay (11.4 vs 12.4 days, P < 0.001), but similar mortality (OR 0.90, 0.71–1.16, 0.418) and survival (HR 0.96, 0.89–1.05, P = 0.378). Conclusion 

One third of patients were operated on by trainees, who were more likely to perform supervised resections in colorectal teams. There was no difference in anastomotic leaks rates, operative mortality or survival between unsupervised trainees, supervised trainees and consultants when case-mix adjustment was applied. This study would suggest that there is considerable underused training capacity available.

Keywords: Colorectal cancer; population audit; surgical outcomes; surgical training

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1463-1318.2007.01465.x

Affiliations: 1: Department of Surgery, North Tyneside General Hospital, Rake Lane, North Shields, Tyne & Wear, UK 2: Wolfson Research Institute, Durham University, Queen’s Campus, University Boulevard, Stockton on Tees, UK 3: Northern Region Colorectal Cancer Audit Group (NORCCAG), Centre for Life, Institute of Human Genetics, Times Square, Newcastle upon Tyne, UK 4: Department of Surgery, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland, UK 5: James Cook University Hospital, Middlesbrough, UK

Publication date: October 1, 2008

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