Study Examines Impact of Specialty and Trainee Involvement on Esophagectomy Outcomes

A study being presented Tuesday has found that allowing trainees to participate in esophagectomies does not influence patient outcomes. And while the specialty of the surgeon performing the procedure doesn’t affect mortality, it may have an impact on other outcomes.

Zeyad Khoushhal, MD, MPH

Senior author Daniela Molena, MD and her colleagues conducted a retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program databases (2005-2013). Zeyad Khoushhal, MD, MPH will report on the findings during Tuesday’s General Thoracic Session: Esophageal, which will be held from 1:00 p.m. to 3:00 p.m. in Room 125AB.

More than 15,000 esophagectomy patients, who were 18 years and older, were divided into two groups, those with surgeries performed by general surgeons (69.8%) and those with surgeries performed by cardiothoracic surgeons (30.2%). Dr. Khoushhal and his colleagues compared intraoperative and postoperative outcomes.

They found that while patients treated by cardiothoracic surgeons had significantly higher comorbidities, cancer rates, and trainee involvement with their surgeries, there was no significant difference in mortality.

Daniela Molena, MD

However, they found that in those procedures performed by general surgeons, patients experienced an increase in serious morbidity, longer hospital stay, and decreased odds for home discharge.

When researchers evaluated trainee involvement as an independent factor, no significant differences were seen in patient outcomes.

Dr. Khoushhal conducted the study while working on his master’s degree in public health at Johns Hopkins Bloomberg School of Public Health in Baltimore. He is now a Postdoctoral Research Fellow at St. Michael’s Hospital in Toronto. Dr. Molena was his mentor.

“As academic surgeons, it’s our responsibility to train residents and students. I am happy to see there was really no difference in the outcomes when there was trainee involvement,” Dr. Molena said. “At the end of the day, the responsibility of the case is on the attending. It is important that the operation is done in a way that is safe for the patient and provides an optimal outcome, but, at the same time, it allows trainees to learn how to become good surgeons. These data are important because they show that the outcome doesn’t change whether the trainee is involved or not.”

She noted that patients who seek treatment from cardiothoracic surgeons typically are sicker.

“I’m not surprised to see more cancer, more COPD, and more congestive heart failure. Patients who are sicker are going to see specialists for care,” said Dr. Molena, who is now an Associate Attending and Director of the Esophageal Surgery Program at Memorial Sloan Kettering Cancer Center and an Associate Professor at Weill Cornell Medical College, New York.