Adrenalectomy outcomes are superior with the participation of residents and fellows.
BACKGROUND
Adrenalectomy is a complex procedure performed in many settings, with and without residents and fellows. Patients often ask, "Will trainees be participating in my operation?" and seek reassurance that their care will not be adversely affected. The purpose of this study was to determine the association between trainee participation and adrenalectomy perioperative outcomes.


METHODS
We performed a cohort study of patients who underwent adrenalectomy from the 2005 to 2011 American College of Surgeons NSQIP database. Trainee participation was classified as none, resident, or fellow, based on postgraduate year of the assisting surgeon. Associations between trainee participation and outcomes were determined via multivariate linear and logistic regression.


RESULTS
Of 3,694 adrenalectomies, 732 (19.8%) were performed by an attending surgeon with no trainee, 2,315 (62.7%) involved a resident, and 647 (17.5%) involved a fellow. The participation of fellows was associated with fewer serious complications (7.9% with no trainee, 6.0% with residents, and 2.8% with fellows; p < 0.001). In a multivariate model, the odds of serious 30-day morbidity were lower when attending surgeons operated with residents (odds ratio = 0.63; 95% CI, 0.45-0.89). Fellow participation was associated with significantly lower odds of overall (odds ratio = 0.51; 95% CI, 0.32-0.82) and serious (odds ratio = 0.31; 95% CI, 0.17-0.57) morbidity. There was no significant association between trainee participation and 30-day mortality.


CONCLUSIONS
In this analysis of multi-institutional data, the participation of residents and fellows was associated with decreased odds of perioperative adrenalectomy complications. Attending surgeons performing adrenalectomies with trainee assistance should reassure patients of the equivalent or superior care they are receiving.
Department of Surgery, University of California, San Francisco, San Francisco, CA. Electronic address: Carolyn.Seib@ucsfmedctr.org.
Carolyn D
CD
Seib
Department of Surgery, Sharp Rees-Stealy Medical Group, San Diego, CA.
David Y
DY
Greenblatt
Department of Surgery, University of California, Davis, Davis, CA.
Michael J
MJ
Campbell
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Wen T
WT
Shen
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Jessica E
JE
Gosnell
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Orlo H
OH
Clark
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Quan-Yang
QY
Duh
D000315:Adrenalectomy / Q000193:education / Q000401:mortality / Q000592:standards*; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D016208:Databases, Factual; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D014481:United States