Transferencia de autonomía operatoria en apendicectomía abierta y laparoscópica: Un estudio de métodos mixtos desde la perspectiva de residentes y supervisores

Introduction. There is limited information on the appropriate development of surgical learning curves, with high levels of autonomy, in general surgery residents in Colombia. The objective of this study was to characterize the levels of autonomy for performing laparoscopic or open appendectomy in a specialization program, from the perspective of resident physicians and supervisors. Methods. Study carried out in two phases. The first phase included the prospective collection of information on each procedure (open or laparoscopic appendectomy), performed between August 2015 and December 2018, in which 29 resident physicians participated. Each resident evaluated his/her function (surgeon, assistant), the level of supervision and the level of intraoperative autonomy using the Zwisch Scale (EZ). In the second phase (qualitative), a total of 15 general surgeons were interviewed who supervised the residents' practice with questions that sought to explain the quantitative findings. Results. 1732 interventions were analyzed: 629 (36 %) were performed open and 1103 (63 %) were performed laparoscopically. 81,4 % (n = 1411) of the procedures were performed in private hospitals. The global perception of autonomy reported by residents according to the Zwisch Scale had level A 28,9 % (n = 500), level B 18,1 % (n = 313), level C 30,4 % (n = 526) and level D 22,7 % (n = 393). 35,2 % (n = 388) of laparoscopic appendectomies and 17,8 % (n = 112) by open approach were performed with a level A, while 19,5 % (n = 215) of laparoscopic appendectomies and 28,2 % (n = 178) by open approach were performed with a level D. The explanation of the quantitative findings was the frequency of open appendectomies in public hospitals, aspects related to the transfer of autonomy to the resident and the patient. progressive increase in the level of advanced autonomy between 2015-2018. Discusion. A higher level of autonomy was found in performing open appendectomy compared with the laparoscopic approach, and levels of autonomy were higher in public hospitals. The explanation for these findings was related to the clinical and professional context of the residents.