title: Postoperative complications at a university hospital: is there a difference between patients operated by supervised residents vs. trained surgeons?
abstract: BACKGROUND
  The surgical residency system ensures supervised practices to progressively move from simple to complex surgical procedures. However, ethical dilemmas could arise if patient outcome is negatively affected by this learning methodology. The objective of this study was to evaluate whether the supervised participation of residents acting as operating surgeons influences the postoperative complication rate.
  
  
  METHODS
  Surgeries performed between June 2010 and May 2011 were analyzed. The Dindo-Clavien classification was used to stratify the severity of complications. The complication rates of patients operated by supervised residents (SR) and trained surgeons (TS) were compared considering potential confounders related to the patient and surgical procedure.
  
  
  RESULTS
  A total of 3697 consecutive surgical procedures were included. Age, gender, and American Society of Anesthesiologists (ASA) risk were not different between patients of both groups. The overall complication rate was 10.8 %, without significant differences between the SR and TS groups (9.8 vs. 11.4 %; P = 0.14). The severity of complications was similar in both groups. Multivariate analysis adjusted for confounders confirmed that resident participation was not an independent risk factor for complications (odds ratio 1.52; 95 % CI 0.79-2.92; P = 0.20).
  
  
  CONCLUSIONS
  Supervised resident participation, as operating surgeon, does not negatively impact postoperative patient outcome. Residency training may therefore be considered as an ethical and safe learning methodology whenever implemented in the framework of an academic teaching hospital.
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina, martin.desantibanes@hospitalitaliano.org.ar.
authors.forename: Martin
authors.initials: M
authors.lastname: de Santibañes
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.forename: Esteban
authors.initials: E
authors.lastname: Sieling
authors.forename: Hernan
authors.initials: H
authors.lastname: Vaccarezza
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Vaccaro
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000193:education*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000193:education*