title: The Impact of Resident Participation in Outpatient Plastic Surgical Procedures.
abstract: BACKGROUND
  Ensuring patient safety along with a complete surgical experience for residents is of utmost importance in plastic surgical training. The effect of resident participation on the outcomes of outpatient plastic surgery procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a prospective, validated, national database.
  
  
  METHODS
  We identified all outpatient procedures performed by plastic surgeons between 2007 and 2012 in the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models assessed the impact of resident participation when compared to attendings alone on 30-day wound complications, overall complications, and return to the operating room (OR).
  
  
  RESULTS
  A total of 18,641 patients were identified: 12,414 patients with an attending alone and 6227 with residents participating. The incidence of overall complications, wound complications, and return to OR was increased with resident participation. When confounding variables were controlled for in multivariate analysis, resident participation was no longer associated with increased risk of wound complications. When stratified by year, incidence of overall complications, wound complications, and return to OR in the resident participation group are trending down and fail to be significantly different in 2011 and 2012. Multivariate analysis shows a similar trend.
  
  
  CONCLUSIONS
  Resident participation is no longer independently associated with increased complications in outpatient plastic surgery in recent years, suggesting that plastic surgical training is successfully continuing to improve in both outcomes and safety. Additional prospective studies that characterize patient outcomes with resident seniority and the degree of resident participation are warranted.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, 5 E 98th Street, 14th Floor, New York, NY, 10029, USA. Ben.massenburg@icahn.mssm.edu.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Massenburg
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 14th Floor, New York, NY, 10029, USA.
authors.forename: Paymon
authors.initials: P
authors.lastname: Sanati-Mehrizy
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 14th Floor, New York, NY, 10029, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Jablonka
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 14th Floor, New York, NY, 10029, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000193:education*; D002983:Clinical Competence; D015331:Cohort Studies; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D061214:Patient Safety; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000193:education*; D016896:Treatment Outcome; D014481:United States
keywords: NSQIP; Outcomes; Outpatient plastic surgery; Resident involvement; Resident participation