title: Appendectomy by residents is safe and not associated with a higher incidence of complications: a retrospective cohort study.
abstract: OBJECTIVE
  The purpose of this retrospective cohort study was to investigate whether current practice where residents perform appendectomies affects quality of care. Therefore, we investigated whether there was a difference in incidence of complications and mortality in appendectomies performed by surgeons (S), supervised residents (SR), or unsupervised residents (UR).
  
  
  BACKGROUND
  Appendicitis is among the most frequent conditions requiring urgent surgery. Admittance and surgery are often managed by residents. Recent studies have shown that laparoscopic appendectomy can be safely performed by residents. It is not known whether these results are applicable on appendectomies in general.
  
  
  METHODS
  All patients undergoing appendectomy in our hospital between January 1, 2000, and December 31, 2009, were included in the analysis. Patients undergoing appendectomy by surgeons, supervised residents, and unsupervised residents were compared. Primary endpoints were complications and mortality.
  
  
  RESULTS
  During the study period, 1538 patients were operated. The risk of complications (S: 20% vs SR: 17% vs UR: 16%; P = 0.209, S vs SR; P = 0.149, S vs UR; and P = 0.872, SR vs UR) and mortality (S: 0.3% vs SR: 0.2% vs UR: 0.4%, P = 1.000 for all comparisons) were similar in all groups. In the multivariate model, the odds ratio for complications in the group operated by supervised residents was 0.84 (95% CI: 0.58-1.22, P = 0.357) versus 0.81 (95% CI: 0.55-1.18, P = 0.265) in the unsupervised residents' group.
  
  
  CONCLUSIONS
  Current practice where residents perform appendectomies either unsupervised or supervised by an experienced surgeon should not be discouraged. We found that it is safe and does not lead to more complications or negatively affect quality of care.
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands. l.graat@elisabeth.nl
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Graat
authors.forename: Eelke
authors.initials: E
authors.lastname: Bosma
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000401:mortality; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult