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Impact of Resident Participation in Surgical Operations on Postoperative Outcomes
Ravi P Kiran*1, Usama Ahmed Ali*1, John C Coffey*1, Jon D Vogel*1, Naveen Pokala*2, Lei Lian*1, Victor Fazio1
1Cleveland Clinic, Cleveland, OH;2University of Missouri, Columbia, MO

OBJECTIVE:
To evaluate whether resident participation in operations influences postoperative outcomes while accounting for patient, disease and operation complexity.
METHODS:
From the National Surgical Quality Improvement Program database (2005-2007), postoperative outcomes for patients with (RES) and without resident (no-RES) participation matched 2:1 based on age, gender, speciality, surgical procedure, morbidity probability and important co-morbidities and risk factors were compared.
RESULTS:
RES (40,474 (66.7%)) and No-RES (20,237 (33.3%)) groups had comparable age, gender, surgical procedure, co-morbidities and morbidity probability. Mortality was similar (0.20% vs. 0.18%, p=0.55). 30-day complications classified as “mild” (7.5% vs 6.7%, p<0.001) and “surgical” (7% vs 6.2%, p<0.001) were higher in RES, but “severe” and “medical” complications were similar. PGY 0-2, 3-5 and ≥6 residents performed 30.5%, 56.1% and 13.4% operations respectively. Overall complications were lower for PGY 0-2 residents (5.9%) than for other years (PGY 3-5: 8.2%, PGY ≥ 6: 8.7%, p10%, respectively).
CONCLUSIONS:
Resident involvement in surgical procedures is safe. The small overall increase in mild surgical complications is likely related to the requirement of resident participation in more complicated operations for patients with more severe and complex disease. Considering the absence of increased complications in PGY 0-2, enhanced supervision of PGY ≥3 residents may improve their surgical skills and promote patient outcomes.
Characteristics and outcomes of surgery with and without resident participation
Characteristic / outcomeResident
(n=40,474)
No Resident
(n=20,237)
P-value
Age [median (IQR)]50 (37-62)50 (37-62)0.8
Sex (male) 13,414 (33.1%)6,707 (33.1%)>0.99
Morbidity probability0.09 +/- 0.050.09 +/- 0.050,36
Diabetes2608 (6.4%)1304 (6.4%)1
ASA-classification
1-No Disturbance
2-Mild Disturbance
3-Severe Disturbance
4-Life Threatening
5404 (13.4%)
23090 (57.0%)
11896 (29.4%)
84 (0.21%)
2702 (13.4%)
11545 (57.0%)
5948 (29.4%)
42 (0.21%)
1
Death within 30 days71 (0.18%)40 (0.20%)0.55
Any 30-day Complication3030 (7.5%)1353 (6.7%)<0.001
Complications classified*
- Surgical Complications
- Medical Complications
- Severe Complications
- Mild Complications
2840 (7.0%)
1481 (3.7%)
2346 (5.8%)
1789 (4.4%)
1255 (6.2%)
705 (3.5%)
1142 (5.6%)
714 (3.5%)
<0.001
0.27
0.44
<0.001
* Surgical and medical complications are listed below. Mild complications are indicated by ‘(mild)’.
• Surgical complications: superficial surgical site infection (mild), deep (organ) surgical site infection, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, peripheral nerve injury (mild) and reoperation.
• Medical complications: pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, sepsis, urinary tract infection (mild), deep venous thrombosis (mild), and thrombophlebitis (mild).


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