title: Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy.
abstract: BACKGROUND
  We evaluated effect of resident involvement on outcomes after laparoscopic and open colon resection for malignancy.
  
  
  METHODS
  Patients undergoing colectomy were queried using the American College of Surgeons' National Surgical Quality Improvement Program. "Attending alone" and "Resident" cohorts were compared with primary end point of overall morbidity.
  
  
  RESULTS
  Of 37,330 patients, residents were involved in 26,190 (70.2%) cases. Attending alone patients were older with higher vascular, cardiac, and pulmonary comorbidity. Univariate analysis demonstrated increased operative time (181.0 ± 98.4 vs 138.7 ± 77.0, P < .001), reoperation (5.7% vs 5.2%, P = .041), and readmission rates (11.9% vs 9.6%, P = .037) with resident involvement. Serious (16.0% vs 13.9%, P < .001), minor (17.5% vs 14.1%, P < .001), and overall morbidity (26.4% vs 22.5%, P < .001) were higher with resident participation. Mortality (2.0% vs 2.8%, P < .001) and failure to rescue (.8% vs 1.2%, P < .029) were lower with resident involvement. Resident involvement showed independent association with overall morbidity in both laparoscopic (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.38, P < .001) and open cases (odds ratio 1.3, 95% confidence interval, 1.18 to 1.35, P < .001).
  
  
  CONCLUSIONS
  Resident participation in colectomy for malignancy is associated with lower mortality at the expense of higher overall morbidity.
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Sippey
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Manwaring
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pofahl
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, 2MA234, Greenville, NC, 27834, USA. Electronic address: kastenk14@ecu.edu.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010348:Patient Care Team / Q000458:organization & administration; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D016019:Survival Analysis
keywords: Cancer; Colectomy; Morbidity; NSQIP; Oncology; Outcome; Resident; SSI