8 - THE SAFE CHOLECYSTECTOMY: EVALUATING USE OF LAPAROSCOPIC SUBTOTAL CHOLECYSTECTOMY BETWEEN JUNIOR AND SENIOR FACULTY

Objectives: Laparoscopic Subtotal Cholecystectomy is a useful technique for performing a safe cholecystectomy in cases where excessive inflammation prevents the exposure of the Critical View of Safety. In a prior study, we noted the need for subtotal cholecystectomy to be associated with increasing age, male sex, and higher ASA class. Several studies have been performed to evaluate perioperative outcomes and complications of laparoscopic cholecystectomy, with mixed results in terms of surgeon experience. It is unclear if the rate of subtotal cholecystectomy is associated with surgeon experience. We hypothesized that the rate of subtotal cholecystectomy would decrease as surgical experience increased.

Methods: We performed a single center, retrospective review of laparoscopic cholecystectomies performed by an Acute Care Surgery service at a tertiary academic medical center. Demographics were analyzed using descriptive statistics. We performed a multivariable logistic regression to examine the relationship between years in practice and performance of subtotal cholecystectomy. We then performed a sensitivity analysis comparing those in their first year on faculty with all others.

Results: Between November 1, 2017, and November 1, 2021, there were 1,222 laparoscopic cholecystectomies performed. 771 patients (63%) were female. 89 patients (7.3%) underwent subtotal cholecystectomy. There were no bile duct injuries requiring reoperation or reconstruction. Controlling for age, sex, and ASA class, there was no difference in the rate of subtotal cholecystectomy by years of experience (OR 0.98, 95% CI 0.94 – 1.01). In a sensitivity analysis comparing first-year faculty to those beyond their first year, there was also no difference (OR 0.76, 95% CI 0.42-1.39).

Conclusion: In this retrospective review, we find no difference in the rate of performance of subtotal cholecystectomy between junior and more experienced faculty. This reflects consistency across seniority levels, in keeping with multi-society best practice guidelines. These results can be confounded by junior faculty requesting assistance during more difficult operations. Further investigation into surgeon and patient factors affecting decision making may shed light on this.