Declining Operative Experience in Pulmonary Resections for Cancer Among Trainees at Veterans Affairs Hospitals: A Concerning Trend in Thoracic Surgical Education.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 40742209.
- Also identified by DOI 10.1097/XCS.0000000000001537 and PMC identifier 12753298.
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Abstract
There is substantial heterogeneity in thoracic surgery exposure among surgical trainees. This study analyzed national trends and outcomes of trainee involvement in surgery for early-stage lung cancer at Veterans Affairs (VA) hospitals, a major clinical training site. We conducted a retrospective cohort study of patients undergoing surgery for stage I non-small cell lung cancer at VA hospitals between 10/01/2006 and 12/31/2020. We compared outcomes of patients who had their operations performed by attending surgeons and those who had operations with a resident or fellow involved. Cochran-Armitage tests were utilized to analyze temporal trends in intraoperative trainee involvement. Multivariable regression models were used to evaluate the association between trainee involvement and postoperative outcomes. In total, 10,175 Veterans were included. Trainees participated in 4,887 (48.0%) operations (median postgraduate year level: 5, interquartile range: 4-6). The percentage of operations with trainees involved decreased from 63.1% in late 2006, to 44.2% in 2013, and to 29.2% in 2020 (p<0.001). In multivariable analyses, operation duration (p=0.133), major complications (p=0.222), prolonged hospitalization (p=0.989), readmission (p=0.704), 90-day mortality (p=0.813), and overall survival (p=0.337) were similar between patients with attending performed and trainee-involved operations. In subgroup analyses by surgical approach, similar findings were observed, except trainee involvement was associated with longer operation duration by 19.5 minutes (confidence interval: 9.7-29.3, p<0.001) in operations performed via thoracotomy (n=5,464, 53.9%). Despite not being associated with increased patient morbidity or mortality, trainee involvement in surgery for early-stage lung cancer at VA hospitals has significantly decreased over the past decade. VA teaching hospitals may offer a suitable learning environment for surgical training programs interested in increasing trainee exposure to core thoracic procedures.