title: Resident education in the era of patient safety: a nationwide analysis of outcomes and complications in resident-assisted oncologic surgery.
abstract: BACKGROUND
  Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality.
  
  
  METHODS
  A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. Colorectal, hepatopancreaticobiliary, and gastroesophageal oncology procedures were included. Multivariate logistic regression was used to assess the impact of trainee involvement on 30-day morbidity and mortality after adjusting for potential confounders.
  
  
  RESULTS
  A total of 77,862 patients were included for analysis, 53,885 (69.2%) involving surgical trainees and 23,977 (30.8%) without trainees. The overall 30-day morbidity was significantly higher in the trainee group [27.2 vs. 21%, adjusted odds ratio (AOR) 1.19, 95% confidence interval (CI) 1.15-1.24, p < 0.0001)]; however, there was significantly lower 30-day postoperative mortality in the trainee group (1.9 vs. 2.1%, AOR 0.87, 95% CI 0.77-0.98, p = 0.02) and significantly lower failure-to-rescue rate (defined as mortality rate among patients suffering one or more postoperative complications) (5.9 vs. 7.6%, AOR 0.79, 95% CI 0.68-0.90, p = 0.001). The overall 30-day morbidity was highest in the PGY 5 level (29%) compared to 24% for PGY 1 or 2 and 23% for PGY 3 (AOR per level increase 1.05, 95% CI 1.03-1.07, p < 0.0001).
  
  
  CONCLUSIONS
  Trainee participation in complex, oncologic surgery is associated with significantly higher rates of 30-day postoperative complications in NSQIP-participating hospitals; however, this effect is countered by overall lower 30-day mortality and improved rescue rate in preventing death among patients suffering complications.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA, anthony.castleberry@duke.edu.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: John
authors.initials: J
authors.lastname: Migaly
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ferranti
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
mesh_terms: D000368:Aged; D002983:Clinical Competence; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D010820:Physicians; D011183:Postoperative Complications; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors