Trust the trainees: a retrospective propensity score-matched cohort study of emergency adhesiolysis outcomes between trainees and board-certified surgeons

Objectives Emergency surgery is a key component of surgical training. Intestinal obstruction due to adhesions is a common emergency in general surgery that often requires complex and individualized adhesiolysis. Despite its clinical relevance, little is known about surgical trainee involvement in these procedures. This study examines the frequency of trainee participation in emergency adhesiolysis and compares short-term outcomes with those of board-certified surgeons. Methods This retrospective cohort study analyzed 333 patients who underwent emergency adhesiolysis for adhesive small bowel obstruction between 2003 and 2020. Propensity score matching (1:1) was performed based on the procedure, diagnosis, age, and American Society of Anesthesiologists (ASA) score. Logistic regression analyses were used to identify factors associated with postoperative complications (CDC≥3). Results Among the 333 procedures, 47 were performed by supervised trainees, and 286 were performed by board-certified surgeons. After matching, 76 patients were included in the final analysis. Baseline characteristics were comparable between the groups. The operative time was significantly shorter in the trainee group (p=0.005) with no significant differences in intra- and postoperative complications or 30-day mortality. In multivariable regression, ASA score (OR 2.56; 95 % CI 1.28–5.13; p=0.008) and age (OR 1.04; 95 % CI 1.01–1.08; p=0.012) were identified as independent risk factors for complications. Conclusions Our findings suggest that emergency adhesiolysis can be performed by advanced surgical trainees under appropriate supervision and is not associated with increased postoperative morbidity. However, trainee involvement in such procedures remains limited.