Impact of resident participation in surgical operations on postoperative outcomes: National Surgical Quality Improvement Program.

OBJECTIVE To evaluate whether resident participation in operations influences postoperative outcomes. BACKGROUND : Identification of potential differences in outcome associated with resident participation in operations may facilitate planning from educational and health resource perspectives. METHODS From the National Surgical Quality Improvement Program database (2005-2007), postoperative outcomes were compared for patients with and without resident participation (RES vs no-RES). Groups were matched in a 2:1 ratio, based on age, sex, specialty, surgical procedure, morbidity probability, and important comorbidities and risk factors. RESULTS RES (40,474; 66.7%) and no-RES (20,237; 33.3%) groups were comparable for matched characteristics. Mortality was similar (0.18% vs 0.20%, P = 0.55). Thirty-day complications classified as "mild" (4.4% vs 3.5%, P < 0.001) and "surgical" (7% vs 6.2%, P < 0.001) were higher in RES group. Individual complications were largely similar, except superficial surgical site infection (3.0% vs 2.2%, P < 0.001). Operative time was longer in the RES group [mean (SD) 122 (80) vs 97 (67) minutes, P < 0.001]. Overall complications were lower for postgraduate year 1-2 residents than for other years. These differences persisted on multivariate analysis adjusting for confounders. CONCLUSIONS Resident involvement in surgical procedures is safe. The small overall increase in mild surgical complications is mostly caused by superficial wound infections. Reasons for this are likely multifactorial but may be related to prolonged operative time.