Outcomes associated with resident involvement in partial colectomy.

ABSTRACT

BACKGROUND: Surgical cases that include trainees are associated with worse outcomes in comparison with those that include attending surgeons alone. OBJECTIVE: This study aimed to identify whether resident involvement in partial colectomy was associated with worse outcomes when evaluated by surgical approach and resident experience. DESIGN: This is a retrospective study using the National Surgical Quality Improvement Program database. SETTINGS This study evaluates cases included in the National Surgical Quality Improvement Program database. PATIENTS All patients were included who underwent partial colectomy including both open and laparoscopic approaches. INTERVENTIONS: Residents were involved. MAIN OUTCOME MEASURES: The primary outcome measures were the association of resident involvement and major complication events, minor complication events, unplanned return to operating room, and operative time. RESULTS: Cases with residents were associated with major complications (OR 1.18, CI 1.09-1.27, p < 0.001) on multivariate analysis. However, after including operative time in the model only open cases involving fifth year residents were still associated with major complications (OR 1.13, p = 0.037). Resident involvement was associated with increased likelihood of minor complications (OR 1.3, p < 0.001) and an increased risk of unplanned return to the operating room (OR 1.20, p < 0.001). Operative time was longer for cases with residents on average by 33.7 minutes and 27 minutes for open and laparoscopic cases. LIMITATIONS: This study was limited by its retrospective design and lack of data on teachings status, case complexity, and intraoperative evaluation of technique. CONCLUSIONS: Resident involvement in partial colectomies is associated with an increased major complications, minor complications, likelihood of return to the operating room, and operative time.