title: Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?
abstract: BACKGROUND
  Despite recognition of racial/ethnic surgical disparities, few studies have considered the role of surgical residents. This study aimed to elucidate whether disparities in postoperative outcomes are associated with the presence/level of surgical residents involved in procedures.
  
  
  METHODS
  Patients who were classified as having laparoscopic cholecystectomy, laparoscopic appendectomy, and open hernia repair in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database were compared by level of provider (junior residents postgraduate year 1-2, senior residents, attending alone) for differences in patient demographics, clinical case-mix, and postoperative outcome information by the use of descriptive statistics and multivariable logistic regression.
  
  
  RESULTS
  A total of 196,770 patients met inclusion criteria. Attendings performed 43.0% of operations alone (senior residents 37.5%, junior residents 20.1%), They operated on 44.1% white, 30.1% black, and 43.9% Hispanic patients compared with 35.5%, 48.7%, and 41.3% and 20.4%, 21.3%, and 14.8% for senior and junior residents, respectively. Compared with attendings alone, senior residents were more likely to operate on black patients (adjusted odds ratio [OR] 2.02, 95% confidence interval [95% CI] 1.95-2.09) and have major (OR 1.13, 95% CI 1.06-1.21) and minor complications (OR 1.20, 95% CI 1.11-1.31). Junior residents also were more likely to operate on black patients but did not experience significantly worse outcomes.
  
  
  CONCLUSIONS
  Greater risk-adjusted odds of complications among patients treated by senior residents need to be carefully weighed given the group's higher likelihood of operating on minority patients.
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC.
authors.forename: Navin R
authors.initials: NR
authors.lastname: Changoor
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC.
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.affiliation: Howard University College of Medicine, Washington, DC.
authors.forename: Mina
authors.initials: M
authors.lastname: Ekladios
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: ahhaider@partners.org.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000193:education; D017081:Cholecystectomy, Laparoscopic / Q000193:education; D002983:Clinical Competence; D016208:Databases, Factual; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D059685:Herniorrhaphy / Q000193:education; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000208:ethnology / Q000209:etiology*; D012189:Retrospective Studies; D014481:United States; D044465:White People