Journal of the American College of Surgeons | 2021
Novel Method of Evaluating Liver Transplant Surgery Fellows Using Objective Measures of Operative Efficiency and Surgical Outcomes.
Abstract
BACKGROUND\nThe majority of liver transplants (LT) in North America are performed by transplant surgery fellows with attending surgeon supervision. While a strict case volume requirement is mandatory for graduating fellows, no guidelines exist on providing constructive feedback to trainees during fellowship.\n\n\nSTUDY DESIGN\nA retrospective review of all adult LTs performed by abdominal transplant surgery fellows at a single ASTS-accredited academic institution from 2005-2019 was conducted. Data from the most recent 5 fellows were averaged to generate reference learning curves for eight variables representing operative efficiency (i.e. total operative time, warm ischemia time, cold ischemia time) and surgical outcomes (i.e. intraoperative blood loss, unplanned return to the operating room, biliary complications, vascular complications, patient/graft loss). Data for newer fellows were plotted against the reference curves at 3-month intervals to provide an objective assessment measure.\n\n\nRESULTS\n352 adult LTs were performed by 5 fellows during the study period. Mean patient age was 56 years; 67% were males; and average MELD at transplant was 22. For the eight primary variables, mean values included the following: total operative time 330 minutes, warm ischemia time 28 minutes, cold ischemia time 288 minutes, intraoperative blood loss 1.59 L, biliary complications 19.6%, unplanned return to OR 19.3%, vascular complications 2.3%. A structure for feedback to fellows was developed using a printed report card and through in-person meetings with faculty at 3-month intervals.\n\n\nCONCLUSION\nComparative feedback using institution-specific reference curves can provide valuable objective data on progression of individual fellows. It can aid in the timely identification of areas in need of improvement, which enhances the quality of training and has the potential to improve patient care and transplant outcomes.