title: The effect of trainee involvement on perioperative outcomes of abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Although the effect of trainee involvement has been evaluated across different specialties, their effects on perioperative outcomes after abdominal aortic aneurysm (AAA) repair have not been examined. Our goal was to examine the association between resident and fellow intraoperative participation with perioperative outcomes of endovascular AAA repair (EVAR), open infrarenal AAA repair (OIAR), and open juxtarenal AAA repair (OJAR).
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program data set (2005-2012) was queried to identify all patients who underwent EVAR, OIAR, or OJAR. Multivariate analysis was performed to assess the association of trainee involvement with perioperative morbidity and mortality.
  
  
  RESULTS
  We identified 16,977 patients: 12,003 with EVAR, 3655 with OIAR, and 1319 with OJAR. Propensity matching and multivariate analyses revealed that there was no significant difference in perioperative death, cardiac arrest/myocardial infarction, pulmonary, renal, venous thromboembolic, or wound complications, or return to the operating room. However, trainee involvement in AAA repair led to a significant increase in operative time for EVAR (163 ± 77 vs 140 ± 67 minutes; P < .001), OIAR (217 ± 91 vs 185 ± 76 minutes; P < .001), and OJAR (267 ± 115 vs 214 ± 106 minutes; P < .001) and an extended length of stay for EVAR (3.1 ± 5.3 vs 2.8 ± 4.5 days; P < .001) and OIAR (10.6 ± 11.8 vs 9.1 ± 8.9 days; P < .001).
  
  
  CONCLUSIONS
  Trainee participation in aneurysm repair was not associated with major adverse perioperative outcomes. However, it was associated with an increased operative time and length of stay and therefore may lead to increased resource utilization and cost.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass. Electronic address: sebastian.didato@bmc.org.
authors.forename: Sebastian
authors.initials: S
authors.lastname: DiDato
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Department of Biostatistics, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Carla C
authors.initials: CC
authors.lastname: Moreira
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Shah
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University, Boston Medical Center, Boston, Mass.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016208:Databases, Factual; D004502:Education, Medical, Continuing / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States