title: Comparable operative times with and without surgery resident participation.
abstract: BACKGROUND
  Both physicians and patients may perceive that having surgical residents participate in operative procedures may prolong operations and worsen outcomes. We hypothesized that resident participation would prolong operative times and potentially adversely affect postoperative outcomes.
  
  
  OBJECTIVE
  To evaluate the effect of general surgery resident participation in surgical procedures on operative times and postoperative patient outcomes.
  
  
  METHODS
  Retrospective study of general surgery procedures performed during two 1-year time periods, 2007 without residents and 2011 with residents. Procedures included laparoscopic appendectomy and cholecystectomy, thyroidectomy, breast procedure, hernia repair, lower extremity amputation, tunneled venous catheter, and percutaneous endoscopic gastrostomy. The primary outcome was operative time and secondary outcomes included length of stay (LOS) and mortality.
  
  
  METHODS
  Academic general surgery residency program.
  
  
  RESULTS
  There were 2280 operative procedures performed during the 2 periods: 1150 with resident involvement (RES group) and 1130 without residents (NORES group). The RES and NORES groups were similar for patient age (42 vs 41, p = 0.14) and male gender (46% vs 45%, p = 0.68), and there was no difference in overall operative time (68min vs 66min, p = 0.58). More specifically there was no difference in operative time (minutes) for specific procedures including laparoscopic appendectomy (67 vs 71, p = 0.8), thyroidectomy (125 vs 109, p = 0.16), breast procedure (38 vs 26, p = 0.79), hernia repair (61 vs 60, p = 0.74), lower extremity amputation (65 vs 77, p = 0.16), tunneled venous catheter (49 vs 47, p = 0.75), and percutaneous endoscopic gastrostomy (49 vs 46, p = 0.76). However, laparoscopic cholecystectomy took slightly longer in the RES group (71 vs 66, p = 0.02). LOS was shorter during the year with resident involvement (2.6 days vs 3.7 days, p = 0.0004) and there was no difference in mortality (0.17% vs 0.35%, p = 0.45).
  
  
  CONCLUSIONS
  There is no difference in operative time for common general surgery procedures with or without resident involvement. In addition, resident involvement is associated with a decrease in LOS. This information should be used to change physician and patient negative perceptions regarding resident involvement while performing surgical procedures.
authors.affiliation: Department of Surgery, University of Texas Southwestern, Austin, Texas; University Medical Center at Brackenridge, Austin, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Uecker
authors.forename: Kevin
authors.initials: K
authors.lastname: Luftman
authors.forename: Sadia
authors.initials: S
authors.lastname: Ali
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000193:education / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D018794:Problem-Based Learning; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013781:Texas; D016896:Treatment Outcome
keywords: ACGME; Patient Care; Practice-Based Learning and Improvement; RRC; Systems-Based Practice; general surgery; length of stay; operative times; residency