American Surgical Association

Back to Annual Meeting Abstracts

Trainee Participation Affects Outcomes In Emergency General Surgery Procedures: An Analysis Of The Nsqip Database
George Kasotakis*, Aliya Lakha*, Beda Sarkar*, Hiroko Kunitake*, Nicole Kissane-Lee*, Tracey Dechert*, David McAneny*, Peter Burke*, Gerard Doherty
Boston University, Boston, MA

Objective: Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. We aim to identify if a similar effect exists in emergency general surgery.
Methods: We identified 141,010 patients who underwent emergency general surgery procedures in the 2005-2010 NSQIP database. Due to the non-random assignment of complex cases to resident participation, patients were matched (1:1) on known risk factors [age, gender, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t- or chi-squared test. The impact of resident participation on outcomes was assessed with multivariable regression modeling, adjusting for risk factors and operative time.
Results: The most common procedures in the matched cohort (n=83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%) and adhesiolysis (6.6%). Outcomes of the two groups are summarized on table 1. Resident participation was an independent predictor for adverse outcomes (table 2).
Conclusions: Trainee participation is associated with adverse outcomes in emergency general surgery procedures. Remediation strategies could include increased use of simulation in training, and increased faculty supervision of residents.
Matched Cohort (n=83,790)
Overall morbidity3.453.290.199
Length of stay4.59±7.984.97±9.630.019
Wound complications
Superficial wound infection2.783.50<0.001
Deep wound infection0.890.730.011
Organ space infection1.772.27<0.001
Wound dehiscence0.690.630.266
Operative technique
Operative time59.17±44.7875.10±54.77<0.001
Anesthesia time99.92±55.45122.42±66.22<0.001
Intraoperative transfusions2.553.43<0.001
Postoperative bleeding requiring transfusion1.281.120.031
Unplanned return to the OR3.804.220.002
Pulmonary complications
Postoperative pneumonia1.671.850.043
Unplanned reintubation1.151.64<0.001
Failure to wean from ventilation2.062.87<0.001
Cardiovascular complications
Myocardial infarction0.260.270.637
Cardiopulmonary arrest0.320.390.071
Cerebrovascular accident0.130.160.205
Deep venous thrombosis0.620.800.002
Pulmonary embolism0.280.43<0.001
Renal complications
Acute renal failure0.310.340.427
Renal failure requiring dialysis0.430.370.209
Urinary tract infections1.141.45<0.001
Life-threatening infectious complications
Septic shock1.411.510.205

Table 1
Effect of Resident Participation on Outcomes (Controlling for Risk Factors & Operative Time)
Beta Coefficient/
Odds Ratio [95% C.I.]
Length of stay0.43 [0.30-0.56]<0.001
Superficial wound infection1.23 [1.13-1.34]<0.001
Organ space infection1.21 [1.09-1.34]<0.001
Intraoperative transfusion1.20 [1.07-1.34]0.001
Postoperative bleeding requiring transfusion0.78 [0.69-0.90]<0.001
Unplanned return to the OR1.08 [1.00-1.16]0.041
Postoperative pneumonia1.06 [0.94-1.18]0.348
Unplanned reintubation1.38 [1.21-1.57]<0.001
Failure to wean from ventilation1.43 [1.29-1.59]<0.001
Deep venous thrombosis1.25 [1.05-1.49]0.011
Pulmonary embolism1.42 [1.11-1.81]0.005
Urinary tract infections1.23 [1.08-1.40]0.001
Sepsis1.07 [0.97-1.18]0.155

Table 2

Back to Annual Meeting Abstracts