title: The cost of resident education.
abstract: BACKGROUND
  Patients cared for by surgeons with resident coverage have an increase in cost versus those patients cared for by surgeons without resident coverage, despite no significant difference in complications. We evaluated the reasons for the disparate cost.
  
  
  METHODS
  In a single institutional analysis, patients received their care from a group of eight surgeons, four with and four without resident coverage. We analyzed ancillary costs, including pharmacy, radiology, laboratory, and central supply costs, and length of stay, total cost, and hospital margin for these patients. In a separate analysis, we compared data that contributes to cost from the National Surgical Quality Improvement Program (NSQIP) database, including age in years, ASA class I-IV, total operating room time in minutes (min), length of hospital stay in days (d), number of patients with a return to OR in 30 d, and complications.
  
  
  RESULTS
  There were no significant differences in ancillary costs in patients cared for by residents. The length of stay was longer in patients cared for by residents (3.3 versus 4.6 d, no resident versus resident, respectively, P = 0.0001). When adjusted for the length of stay, the difference between total costs was $1949/d versus $2103/d (P = NS) for the no resident versus resident groups, respectively. There were 32,685 patients evaluated in the NSQIP database. In all comparisons, operating room time was significantly longer in patients with procedures involving residents.
  
  
  CONCLUSIONS
  The increase in cost in patients cared for by surgeons with residents is not from significant differences in ancillary costs, and may be from length of stay. Surgical procedures are significantly longer with resident involvement.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Hwang
authors.forename: Keith A
authors.initials: KA
authors.lastname: Wichterman
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Alfrey
mesh_terms: D001062:Appendectomy / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D003107:Colorectal Surgery / Q000191:economics; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D007902:Length of Stay; D008408:Mastectomy / Q000191:economics; D019990:Perioperative Care / Q000191:economics*