title: Comparative Outcomes of Resident vs Attending Performed Surgery: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To determine whether outcomes are different when surgery is performed by resident or attending surgeons, and which variables may affect outcomes.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library were searched from inception to May 2014 alongside the bibliographies of all included or relevant studies. Any study comparing outcomes from surgery performed by resident vs attending surgeons was eligible for inclusion. The main outcome measures were surgical complications (classified by Clavien-Dindo grade), death, operative time, and length of stay. Data were extracted independently by 2 authors and analyzed using the random-effects model.
  
  
  RESULTS
  The final analysis included 182 eligible studies that enrolled 141 555 patients. Resident performed surgery took longer by 10.2 minutes (95% confidence interval (CI): 8.38-11.95), and had more Clavien-Dindo grade 1 (rate ratio = 1.14, 95% CI: 1.02-1.29) and grade 3a complications (rate ratio = 1.22, 95% CI: 1.04-1.44). Resident performed surgery resulted in fewer deaths (risk ratio = 0.83, 95% CI: 0.70-0.999) with a shorter length of stay of -0.49 days (95% CI: -0.77 to -0.21). Significant heterogeneity was present in 7 of 10 outcomes, which persisted during multiple subgroup analyses.
  
  
  CONCLUSIONS
  Resident performed surgery appears to be safe in carefully selected patients. The significant amount of heterogeneity present in the study outcomes prevents generalizability of these results to specific clinical contexts.
authors.affiliation: Department of General Surgery, Salisbury District Hospital, Salisbury, United Kingdom. Electronic address: mrnigeldsouza@gmail.com.
authors.forename: Nigel
authors.initials: N
authors.lastname: D'Souza
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hashimoto
authors.affiliation: UCL Medical School, London, United Kingdom.
authors.forename: Kurinchi
authors.initials: K
authors.lastname: Gurusamy
authors.affiliation: Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, Québec; Department of Surgery, McGill University, Montreal, Québec, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000592:standards*; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D018579:Patient Selection; D011183:Postoperative Complications; D013514:Surgical Procedures, Operative / Q000193:education* / Q000592:standards*
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; patient safety; professional competence; surgical education; surgical procedures; treatment outcomes