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Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality.

Methods

A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005–2009. Colorectal, hepatopancreaticobiliary, and gastroesophageal oncology procedures were included. Multivariate logistic regression was used to assess the impact of trainee involvement on 30-day morbidity and mortality after adjusting for potential confounders.

Results

A total of 77,862 patients were included for analysis, 53,885 (69.2 %) involving surgical trainees and 23,977 (30.8 %) without trainees. The overall 30-day morbidity was significantly higher in the trainee group [27.2 vs. 21 %, adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.15–1.24, p < 0.0001)]; however, there was significantly lower 30-day postoperative mortality in the trainee group (1.9 vs. 2.1 %, AOR 0.87, 95 % CI 0.77–0.98, p = 0.02) and significantly lower failure-to-rescue rate (defined as mortality rate among patients suffering one or more postoperative complications) (5.9 vs. 7.6 %, AOR 0.79, 95 % CI 0.68–0.90, p = 0.001). The overall 30-day morbidity was highest in the PGY 5 level (29 %) compared to 24 % for PGY 1 or 2 and 23 % for PGY 3 (AOR per level increase 1.05, 95 % CI 1.03–1.07, p < 0.0001).

Conclusions

Trainee participation in complex, oncologic surgery is associated with significantly higher rates of 30-day postoperative complications in NSQIP-participating hospitals; however, this effect is countered by overall lower 30-day mortality and improved rescue rate in preventing death among patients suffering complications.

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Disclosure

The authors have no potential conflicts of interest, including specific financial interests, relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Anthony W. Castleberry MD, MMCi, Bryan M. Clary MD, John Migaly MD, Mathias Worni MD, MHS, Theodore N. Pappas MD & John E. Scarborough MD

  2. Department of Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland

    Mathias Worni MD, MHS

  3. Duke Health Technology Solutions, Duke University Medical Center, Durham, NC, USA

    Jeffrey M. Ferranti MD, MS

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  1. Anthony W. Castleberry MD, MMCi
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  2. Bryan M. Clary MD
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  3. John Migaly MD
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  5. Jeffrey M. Ferranti MD, MS
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  6. Theodore N. Pappas MD
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  7. John E. Scarborough MD
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Correspondence to Anthony W. Castleberry MD, MMCi.

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Castleberry, A.W., Clary, B.M., Migaly, J. et al. Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery. Ann Surg Oncol 20, 3715–3724 (2013). https://doi.org/10.1245/s10434-013-3079-2

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