ArticleJournal of the American College of Surgeons2025
Declining Operative Experience in Pulmonary Resections for Cancer Among Trainees at Veterans Affairs Hospitals: A Concerning Trend in Thoracic Surgical Education.
Article in Journal of the American College of Surgeons, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThere 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. STUDY
designWe 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.
resultsIn 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%).
conclusionsDespite 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.
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