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Impact of Residency Training Level on the Surgical Quality Following General Surgery Procedures

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Abstract

Objective

To investigate the safety of surgical performance by residents of different training level performing common general surgical procedures.

Methods

Data were consecutively collected from all patients undergoing general surgical procedures such as laparoscopic cholecystectomy, laparoscopic appendectomy, inguinal, femoral and umbilical hernia repair from 2005 to 2011 at the Department of Surgery of the University Hospital of Zurich, Switzerland. The operating surgeons were grouped into junior residents, senior residents and consultants. The comprehensive complication index (CCI) representing the overall number and severity of all postoperative complications served as primary safety endpoint. A multivariable linear regression analysis was used to analyze differences between groups. Additionally, we focused on the impact of senior residents assisting junior residents on postoperative outcome comparing to consultants.

Results

During the observed time, 2715 patients underwent a general surgical procedure. In 1114 times, a senior resident operated and in 669 procedures junior residents performed the surgery. The overall postoperative morbidity quantified by the CCI was for consultants 5.0 (SD 10.7), for senior residents 3.5 (8.2) and for junior residents 3.6 (8.3). After adjusting for possible confounders, no difference between groups concerning the postoperative complications was detected. There is also no difference in postoperative complications detectable if junior residents were assisted by consultants then if assisted by senior residents.

Discussion

Patient safety is ensured in general surgery when performed by surgical junior residents. Senior residents are able to adopt the role of the teaching surgeon in charge without compromising patients’ safety.

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Financial support

KS was supported by a PROSPER fellowship by the Swiss National Foundation (SNF 3233B_151049). PAC was supported by a Grant from the Liver and Gastrointestinal Disease (LGID) foundation.

Author information

Authors and Affiliations

  1. Department of Surgery and Transplantation, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Dominik Loiero, Maja Slankamenac, Pierre-Alain Clavien & Ksenija Slankamenac

Authors
  1. Dominik Loiero
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  2. Maja Slankamenac
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  3. Pierre-Alain Clavien
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  4. Ksenija Slankamenac
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Corresponding author

Correspondence to Ksenija Slankamenac.

Additional information

Dominik Loiero and Maja Slankamenac: shared first author.

Appendix

Appendix

See Tables 5, 6, 7, 8, 9, 10, 11 and 12.

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Loiero, D., Slankamenac, M., Clavien, PA. et al. Impact of Residency Training Level on the Surgical Quality Following General Surgery Procedures. World J Surg 41, 2652–2666 (2017). https://doi.org/10.1007/s00268-017-4092-6

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  • DOI: https://doi.org/10.1007/s00268-017-4092-6

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