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Objective: A national survey found that 27.5% of general surgery residents do not feel confident performing procedures independently before graduation. We evaluated the characteristics and outcomes of patients undergoing common general surgery procedures by residents without an attending in the operating room (OR).
Design: Retrospective cross-sectional study.
Setting: More than 120 hospitals participating in ACS-NSQIP 2005-08.
Patients: Patients who underwent appendectomy or cholecystectomy with/out surgical resident participation in the OR. They were divided into patients who had surgery by an attending (A), attending with resident (AR), or resident (R). Analyses involved Chi-square, ANOVA, and multivariate regression.
Main outcome measures: Complications, reoperation and mortality within 30 days of surgery, operating time, and hospital length of stay (LOS).
Results: Of 81,695 cases, residents participated in 64%; 884 patients underwent surgery by R. Compared to A and AR patients, R patients were more likely to be non-white, have inpatient, emergent, and open procedures (all p<0.001); they had higher complication rates (4.4%, 5.4% vs. 6.8%), longer operating time (46min, 65min vs. 66min) and LOS (all p<0.001). There were no significant differences in rates of reoperation (1.3%, 1.3% vs.1.5%, p=0.64) and mortality (0.4%, 0.3% vs. 0.3%, p=0.36). After adjustment, a resident operating without an attending present during cholecystectomies and appendectomies was not independently associated with increased complications risk (p=0.77, p=0.61 respectively) or longer LOS (p=0.91, p=0.32 respectively). Compared to A/AR patients, adjusted operating time for R patients who underwent either procedure differed by 1 minute.
Conclusions: Patients who undergo surgery by a resident without an attending in the OR do well. Attending surgeons appear to exercise good judgment in determining extent of intraoperative resident supervision without compromising patient outcomes.