title: Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program.
abstract: OBJECTIVE
  To evaluate whether resident participation in operations influences postoperative outcomes.
  
  
  BACKGROUND
  : Identification of potential differences in outcome associated with resident participation in operations may facilitate planning from educational and health resource perspectives.
  
  
  METHODS
  From the National Surgical Quality Improvement Program database (2005-2007), postoperative outcomes were compared for patients with and without resident participation (RES vs no-RES). Groups were matched in a 2:1 ratio, based on age, sex, specialty, surgical procedure, morbidity probability, and important comorbidities and risk factors.
  
  
  RESULTS
  RES (40,474; 66.7%) and no-RES (20,237; 33.3%) groups were comparable for matched characteristics. Mortality was similar (0.18% vs 0.20%, P = 0.55). Thirty-day complications classified as "mild" (4.4% vs 3.5%, P < 0.001) and "surgical" (7% vs 6.2%, P < 0.001) were higher in RES group. Individual complications were largely similar, except superficial surgical site infection (3.0% vs 2.2%, P < 0.001). Operative time was longer in the RES group [mean (SD) 122 (80) vs 97 (67) minutes, P < 0.001]. Overall complications were lower for postgraduate year 1-2 residents than for other years. These differences persisted on multivariate analysis adjusting for confounders.
  
  
  CONCLUSIONS
  Resident involvement in surgical procedures is safe. The small overall increase in mild surgical complications is mostly caused by superficial wound infections. Reasons for this are likely multifactorial but may be related to prolonged operative time.
authors: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. kiranp@ccf.org
authors: Ravi Pokala
authors: RP
authors: Kiran
authors: U
authors: U
authors: Ahmed Ali
authors: John C
authors: JC
authors: Coffey
authors: Jon D
authors: JD
authors: Vogel
authors: Naveen
authors: N
authors: Pokala
authors: Victor W
authors: VW
authors: Fazio
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000193:education* / Q000401:mortality; D014481:United States