Impact of Residents on Surgical Outcomes in High-Complexity Procedures

Area of Science:

• Surgical Outcomes Research
• Medical Education
• Patient Safety

Background:

• Conflicting views exist regarding the impact of surgical resident involvement on patient outcomes.
• This study investigates whether resident participation affects surgical results.

Purpose of the Study:

• To test the hypothesis that resident involvement in surgical care does not appreciably alter patient outcomes.
• To analyze the association between surgical resident participation and key surgical outcomes.

Main Methods:

• Analysis of a large American College of Surgeons NSQIP dataset for high-complexity procedures across four surgical specialties.
• Evaluation of operative mortality, composite morbidity, and failure to rescue (FTR) in procedures with and without resident involvement.
• Utilized propensity-score matching to control for non-random assignment of residents.

Main Results:

• Unmatched analysis showed higher mortality and morbidity but lower FTR with resident involvement.
• Propensity-matched analysis revealed minor increases in composite morbidity but significant improvements in FTR.
• Senior-level resident involvement (PGY≥6) was associated with improved outcomes, particularly in cardiothoracic surgery.

Conclusions:

• Resident involvement, especially senior residents, is linked to substantial improvements in failure to rescue (FTR).
• Surgical resident participation can attenuate negative impacts on operative mortality and FTR in complex cases.
• Findings support current surgical teaching paradigms, demonstrating reassurance for resident involvement in patient care.