title: Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes.
abstract: BACKGROUND
  The impact of resident surgeon participation during vascular procedures on postoperative outcomes is incompletely understood. We characterized resident physician participation during carotid endarterectomy (CEA) procedures within the 2005-2009 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and evaluated associations with procedural characteristics and perioperative adverse events.
  
  
  METHODS
  CEAs were identified using primary current procedural terminology codes; those performed simultaneously with other major procedures or unknown resident participation status were excluded. Group-wise comparisons based on resident participation status were performed using χ(2) or Fisher's exact test for categorical variables and t tests or nonparametric methods for continuous variables. Associations with perioperative adverse events (major = stroke, death, myocardial infarction, or cardiac arrest; minor = peripheral nerve injury, bleeding requiring transfusion, surgical site infection, or wound disruption) were assessed using multivariable logistic regression models adjusting for other known risk factors.
  
  
  RESULTS
  A total of 25,280 CEA procedures were analyzed, of which residents participated in 13,705 (54.2%), while residents were absent in 11,575 (45.8%). Among CEAs with resident physician participation, resident level was categorized as junior (postgraduate year [PGY] 1-2) in 21.9%, senior (PGY 3-5) in 52.7%, and fellow (PGY ≥6) in 25.3%. Major adverse event rates with and without resident participation were 1.9% versus 2.1%, and minor adverse event rates with and without resident participation were 0.9% versus 1.0%, respectively. In multivariable models, resident physician participation was not associated with perioperative risk for major adverse events (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.75-1.08) or minor adverse events (OR, 0.93; 95% CI, 0.72-1.21).
  
  
  CONCLUSIONS
  Resident surgeon participation during CEA is not associated with risk of adverse perioperative events.
authors: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: James G
authors: JG
authors: Reeves
authors: Karthikeshwar
authors: K
authors: Kasirajan
authors: Ravi K
authors: RK
authors: Veeraswamy
authors: Joseph J
authors: JJ
authors: Ricotta
authors: Atef A
authors: AA
authors: Salam
authors: Thomas F
authors: TF
authors: Dodson
authors: David A
authors: DA
authors: McClusky
authors: Matthew A
authors: MA
authors: Corriere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D019992:Databases as Topic; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D059035:Perioperative Period; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology