Background: Teaching in the operating room represents the cornerstone of surgical education. While residents need to perform enough basic procedures to gain independence, their impact on outcomes remains debated.

Method: We conducted a retrospective study using a Swiss national registry between 2009 and 2019. Patients who underwent laparoscopic cholecystectomy were identified. Baseline characteristics were analyzed, and a propensity score was constructed using age, gender, American Society of Anesthesiologists (ASA) classification, workday status, operation setting, and surgical indication. Patients were then matched in a 2:1 ratio (non-teaching vs. teaching), and surgical outcomes were assessed. The primary outcome was safety, defined by the incidence and severity of postoperative complications.

Results: We included 34,080 cholecystectomies in our analysis. After propensity-score matching, 7038 interventions used for surgical teaching were compared to 14,076 performed by board-certified surgeons. Mean cohort age was 53 years, and 7.7% of patients had an ASA>II. Our analysis found comparable safety outcomes in regard to frequency (1.5 vs. 1.6%, p = 0.5) and severity (Clavien-Dindo ≥IIIa: 42.0 vs. 42.7%, p = 0.8) of postoperative complications. The teaching group had a longer mean operating time (85 ± 38 vs. 73 ± 44 minutes, p < 0.001), while the mean postoperative LOS was comparable between groups (3.70 ± 5.64 days). Multivariate regression analysis identified older age, ASA ≥III, weekend days, and urgent setting as independent negative predictors of teaching.

Conclusion: Teaching residents a common surgical procedure, such as cholecystectomy appears safe, with equally low complication rates and severity, despite longer operative times.

Title	Published in	Access level	OA Policy	Year	Views	Downloads

The Influence of Surgical Teaching on Laparoscopic Cholecystectomy Outcomes : A Retrospective Propensity Score-Matched National Cohort Study	Journal of surgical education			2025	6	55

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Silva Alves, André

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