title: The impact of resident involvement on otolaryngology surgical outcomes.
abstract: OBJECTIVE
  Intraoperative experience is an essential element of surgical training, but has the potential to impact patient outcomes. The purpose of this study was two-fold: 1) to evaluate the effect of resident involvement on morbidity and mortality following otolaryngology procedures and 2) to examine the influence of resident training level on the same outcomes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  This study reviewed 2,320,920 patients captured in the 2005 to 2012 National Surgical Quality Improvement Program databases to identify surgical otolaryngology cases. Outcomes of interest included surgical complications, medical complications, and mortality. Cases with and without resident involvement were propensity matched (caliper = 0.2) to account for nonrandomized assignment, and data were subject to multivariate logistic regression analyses.
  
  
  RESULTS
  Residents participated in 38.4% of the 20,307 cases identified. Cases with resident involvement demonstrated longer operative duration (178.8 minutes vs. 80.1 minutes, P < .001), increased surgical complexity (23.5 relative value units [RVU] vs. 12.4 RVU, P < .001) and greater overall morbidity burden. Logistic regression analyses of the matched cohort revealed that resident participation did not independently increase morbidity (odds ratio [OR] = 0.969, P = .751) or mortality (OR = 0.893, P = .758). A separate logistic regression analysis of the unmatched cohort using resident postgraduate year showed that training level did not confer differential risk to patients.
  
  
  CONCLUSIONS
  Our data indicate that resident involvement does not increase the risk of morbidity or mortality, and that trainees are being assigned to appropriate cases for their level of experience. These findings suggest that the contemporary paradigm of graduate otolaryngology surgical education does not negatively impact patient outcomes.
  
  
  METHODS
  2c Laryngoscope, 126:602-607, 2016.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Vieira
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hernandez
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors.forename: Charles
authors.initials: C
authors.lastname: Qin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Smith
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Dutra
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000193:education*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D057216:Propensity Score; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 30-day complications; National Surgical Quality Improvement Program; Resident training; medical education; surgical outcomes