Resident versus no resident: a single institutional study on operative complications, mortality, and cost.
BACKGROUND
Previous studies have demonstrated an increase in surgical morbidity, mortality, duration of stay, and costs in teaching hospitals. These studies are confounded by many variables. Controlling for these variables, we studied the effect of surgical residents on these outcomes during rotations with non-academic-based teaching faculty at a teaching hospital.


METHODS
Patients received care at a single teaching hospital from a group of 8 surgeons. Four surgeons did not have resident coverage (group 1) and the other 4 had coverage (group 2). Continuous severity adjusted complications, mortality, length of stay, cost, and hospital margin data were collected and compared.


RESULTS
Five common procedures were examined: bowel resection, laparoscopic cholecystectomy, hernia, mastectomy, and appendectomy. Comparing all procedures together, there were no differences in complications between the groups, although there was greater mortality, a greater duration of stay, and higher costs in group 2. When comparing the 5 most common procedures individually, there was no difference in complications or mortality, although a greater length of stay and higher costs in group 2.


CONCLUSIONS
Comparing the most common procedures performed individually, patients cared for by surgeons with surgical residents at a teaching hospital have an increase in duration of stay and cost, although no difference in complications or mortality compared to surgeons without residents.
Hwang
Christine S
CS
The Department of Surgery, Southern Illinois University, Springfield, IL 62794-9638, USA.
Pagano
Christina R
CR
Wichterman
Keith A
KA
Dunnington
Gary L
GL
Alfrey
Edward J
EJ
D001062:Appendectomy / Q000009:adverse effects / Q000191:economics; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics; D013502:General Surgery / Q000193:education*; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery; D017721:Hospital Costs; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008408:Mastectomy / Q000009:adverse effects / Q000191:economics; D010561:Personnel Staffing and Scheduling; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000191:economics / Q000401:mortality