title: Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database.
abstract: OBJECTIVE
  To identify whether resident involvement affects clinically relevant outcomes in emergency general surgery.
  
  
  BACKGROUND
  Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population.
  
  
  METHODS
  We identified 141,010 patients who underwent emergency general surgery procedures in the 2005-2010 Surgeons National Surgical Quality Improvement Program database. Because of the nonrandom assignment of complex cases to resident participation, patients were matched (1:1) on known risk factors [age, sex, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t or χ test. The impact of resident participation on outcomes was assessed with multivariable regression modeling, adjusting for risk factors and operative time.
  
  
  RESULTS
  The most common procedures in the matched cohort (n = 83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%), and adhesiolysis (6.6%). Trainee participation is independently associated with intra- and postoperative events, wound, pulmonary, and venous thromboembolic complications, and urinary tract infections.
  
  
  CONCLUSIONS
  Trainee participation is associated with adverse outcomes in emergency general surgery procedures.
authors.affiliation: Departments of *Surgery; and †Graduate Medical Sciences, Boston University School of Medicine, Boston, MA.
authors.forename: George
authors.initials: G
authors.lastname: Kasotakis
authors.forename: Aliya
authors.initials: A
authors.lastname: Lakha
authors.forename: Beda
authors.initials: B
authors.lastname: Sarkar
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kunitake
authors.forename: Nicole
authors.initials: N
authors.lastname: Kissane-Lee
authors.forename: Tracey
authors.initials: T
authors.lastname: Dechert
authors.forename: David
authors.initials: D
authors.lastname: McAneny
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
authors.forename: Gerard
authors.initials: G
authors.lastname: Doherty
mesh_terms: D000328:Adult; D001062:Appendectomy; D004632:Emergency Medical Services; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*