Background

The effect of surgeon training and volume on bariatric surgery outcomes is well established, however the impact of trainees and other surgeons as first assistants (FA) on outcomes is an area of discussion. We sought to identify the effect of FA level on perioperative outcomes and 30-day mortality.

Methods

MBSAQIP 2016 was the data source. Patients who underwent laparoscopic sleeve gastrectomy(LSG) and laparoscopic gastric-bypass(LGBP) were included. Logistic regression models were created to identify the effect of FA training level and the factors affecting the perioperative outcomes (ICU admission, readmission, reoperation, leak, coma, sepsis, ventilator>48 hours, renal failure, PE) and mortality. Linear regression was used to analyze the effect on operative length.

Results

147,151 patients were identified. 79.5% were female, mean age of 48.1 years. 73.2% (107,726) underwent LSG. Mean operative time was 85 minutes. Compared to a bariatric surgeon, a significant regression equation was found in FA (slope coefficient -0.150, p=0.045) between others, while no difference was seen between fellows, residents, and CSA’s(p=0.218). 30-day mortality rate was 0.1% (124) but the FA training level was not a significant factor (p=0.771). Overall complication rate was 2.2% (3,237 patients). After correcting for confounders, fellows-residents as FA did not have an effect on leak, readmission, reoperation, and ICU admission. However, bariatric surgeon as FA significantly decreased the odds of a leak(OR 0.85, 95% CI 0.67-0.96 p=0.009) and overall complications(OR 0.82 p=0.045).

Conclusions

Trainees as FA does not increase mortality, reoperation rates, or readmission rates after bariatric surgery.