title: Surgical resident involvement is safe for common elective general surgery procedures.
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).
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
authors.forename: Warren H
authors.initials: WH
authors.lastname: Tseng
authors.forename: Leah
authors.initials: L
authors.lastname: Jin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Vijay P
authors.initials: VP
authors.lastname: Khatri
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gauvin
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
authors.forename: David
authors.initials: D
authors.lastname: Wisner
authors.forename: Sandra
authors.initials: S
authors.lastname: Taylor
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
mesh_terms: D002983:Clinical Competence; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D013502:General Surgery / Q000193:education* / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications; D011183:Postoperative Complications; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States