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Understanding the Clinical Implications of Resident Involvement in Uncommon Operations.

Serena S Dasani1, K D Simmons2, C J Wirtalla2

  • 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Journal of Surgical Education
|April 14, 2019
PubMed
Summary

Uncommon surgical operations have high rates of death or serious morbidity (DSM). Resident involvement, particularly senior residents (PGY4+), was linked to reduced failure to rescue (FTR) and potentially improved outcomes.

Keywords:
Patient CarePractice-Based Learning and ImprovementSystems-Based Practicepatient safetyresident educationresident involvementsurgical educationuncommon operationsuncommon surgical procedures

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Area of Science:

  • Surgical outcomes research
  • Patient safety in surgery
  • Surgical education and training

Background:

  • Outcomes of uncommon surgical operations are understudied.
  • Understanding the role of surgical residents in these complex cases is crucial for improving patient safety.

Purpose of the Study:

  • To investigate the incidence of postoperative events in uncommon general surgical operations.
  • To determine the impact of surgical resident involvement on patient outcomes, including death or serious morbidity (DSM) and failure to rescue (FTR).

Main Methods:

  • Utilized the ACS National Surgical Quality Improvement Program Participant Use File (2008-2011).
  • Analyzed 21,453 uncommon operations, stratifying resident involvement by postgraduate year (PGY).
  • Assessed DSM, FTR, and prolonged operative time (PRopt) using multivariate logistic regression.

Main Results:

  • Overall DSM rate was 28.6%.
  • Resident involvement (RI) did not significantly impact DSM but was associated with lower FTR rates (5.1% vs. 8.3% for NRI).
  • Higher PGY levels (PGY4-5 and PGY6+) showed decreased FTR, and RI was linked to prolonged operative time.

Conclusions:

  • Uncommon operations carry substantial risk of DSM.
  • While senior resident involvement (PGY4+) may be associated with lower FTR, the overall impact on DSM requires further investigation.
  • Increased experience of senior residents may contribute to better outcomes in complex surgical cases.