Surgical resident involvement is safe for common elective general surgery procedures

Warren H. Tseng, Leah Jin, Robert J Canter, Steve R. Martinez, Vijay P. Khatri, Jeffrey Gauvin, Richard J Bold, David H Wisner, Sandra Taylor, Steven L. Chen

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalJournal of the American College of Surgeons
Volume213
Issue number1
DOIs
StatePublished - Jul 2011

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Morbidity
Operative Time
Mortality
Odds Ratio
Nonparametric Statistics
Quality Improvement
Graduate Medical Education
Colectomy
Teaching
Multivariate Analysis
Logistic Models
Databases
Education

Keywords

  • ACS NSQIP
  • American College of Surgeons National Surgical Quality Improvement Program
  • CPT
  • current procedural terminology
  • laparoscopic cholecystectomy
  • laparoscopic inguinal hernia repair
  • laparoscopic Nissen fundoplication
  • laparoscopic Roux-en-Y gastric bypass
  • LC
  • LG
  • LH
  • LN
  • OC
  • OH
  • open inguinal hernia repair
  • open right colectomy
  • operative time
  • OpT
  • PGY
  • postgraduate year
  • SRI
  • surgical resident involvement
  • total thyroidectomy
  • TT

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical resident involvement is safe for common elective general surgery procedures. / Tseng, Warren H.; Jin, Leah; Canter, Robert J; Martinez, Steve R.; Khatri, Vijay P.; Gauvin, Jeffrey; Bold, Richard J; Wisner, David H; Taylor, Sandra; Chen, Steven L.

In: Journal of the American College of Surgeons, Vol. 213, No. 1, 07.2011, p. 19-26.

Research output: Contribution to journalArticle

Tseng, Warren H. ; Jin, Leah ; Canter, Robert J ; Martinez, Steve R. ; Khatri, Vijay P. ; Gauvin, Jeffrey ; Bold, Richard J ; Wisner, David H ; Taylor, Sandra ; Chen, Steven L. / Surgical resident involvement is safe for common elective general surgery procedures. In: Journal of the American College of Surgeons. 2011 ; Vol. 213, No. 1. pp. 19-26.
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