Surgical Resident Involvement Is Safe for Common Elective General Surgery Procedures - 10/08/11

Doi : 10.1016/j.jamcollsurg.2011.03.014

Warren H. Tseng, MD ^a, Leah Jin, BS ^d, Robert J. Canter, MD ^a, Steve R. Martinez, MD, MAS, FACS ^a, Vijay P. Khatri, MD, FACS ^a, Jeffrey Gauvin, MD ^b, Richard J. Bold, MD, FACS ^a, David Wisner, MD, FACS ^c, Sandra Taylor, PhD ^d, Steven L. Chen, MD, MBA, FACS ^a,^⁎
^a Department of Surgery, Division of Surgical Oncology, University of California, Davis Medical Center, Sacramento, CA
^b Department of Surgery, Division of Gastrointestinal Surgery, University of California, Davis Medical Center, Sacramento, CA
^c Department of Surgery, Division of Trauma and Critical Care Surgery, University of California, Davis Medical Center, Sacramento, CA
^d Department of Public Health Sciences, University of California, Davis, Sacramento, CA

Correspondence address: Steven L. Chen, MD, MBA, Division of Surgical Oncology, Suite 3010, UC Davis Cancer Center, 4501 X Street, Sacramento, CA 95817

Résumé

Background

Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT).

Study Design

The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests.

Results

A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI.

Conclusions

SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted.

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Abbreviations and Acronyms : ACS NSQIP, CPT, LC, LG, LH, LN, OC, OH, OpT, PGY, SRI, TT

Plan

Perioperative morbidity and mortality

Operative time

Conclusions

Author Contributions

Disclosure Information: Nothing to disclose.

This publication was made possible by grant UL1 RR024146 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH. Information on the NCRR is available at www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from overview-translational.asp.