title: The resident as surgeon: an analysis of ACS-NSQIP.
abstract: BACKGROUND
  Data on the characteristics and outcomes of patients operated on by surgical residents are limited.
  
  
  METHODS
  Using ACS-NSQIP (2005-2008), characteristics and outcomes of patients who underwent cholecystectomy, appendectomy, or inguinal hernia repair by a resident (R) without an attending scrubbed in the operating room, a scrubbed attending with resident (AR), or an attending without resident (A) were pooled and compared. Data analyses involved χ(2), ANOVA, and multivariate regression.
  
  
  RESULTS
  The R group performed <1% of ACS-NSQIP cases; the 10 most common procedures represented 69.1% of cases. There were 912 cases of cholecystectomy, appendectomy, or inguinal hernia repair performed by R. Compared with A/AR patients, R patients were more likely to have inpatient (42.6%, 48.9% versus 64.8%), emergent (28.6%, 30.8% versus 35.5%) , and open procedures (27.0%, 29.4% versus 28.9%) (all P < 0.001). In unadjusted analyses, R patients had higher complication rates (4.8% versus 4.4%, 3.4%, P < 0.001) and longer operating time (64.4 min versus 62.2 min, 44.7 min, P < 0.001) than AR/A patients respectively. After risk adjustment, a resident operating without an attending scrubbed in the operating room was not independently associated with increased complications risk (odds ratio 1.2, 95% CI: 0.8-1.8, P = 0.2). Compared with A/AR patients, there was a 1-min difference in adjusted operating time for patients who underwent surgery by R (P < 0.001).
  
  
  CONCLUSIONS
  In ACS-NSQIP, a resident rarely performs surgery without an attending scrubbed in the operating room; surgical attendings appear to exercise good judgment in determining the appropriate extent of resident supervision in the operating room without compromising patient outcomes.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: Hadiza S
authors.initials: HS
authors.lastname: Kazaure
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D001062:Appendectomy / Q000592:standards / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data; D013502:General Surgery / Q000193:education* / Q000592:standards* / Q000706:statistics & numerical data; D059685:Herniorrhaphy / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods