Quantifying the effect of resident education on outcomes in pediatric appendicitis

Surgical residents are involved in the care of patients in a climate where quality of care is an important outcome measure. The purpose of this study was to evaluate the effect of resident involvement on appendectomy outcomes.

We retrospectively reviewed appendectomies, ages 0-18, from January 2016 to December 2018. Operative time, operative charges, and postoperative outcomes were evaluated for cases with and without a resident. Data were analyzed using Wilcoxon rank and Fisher's exact tests.

Of 1842 appendectomies (1267 resident present and 575 no resident present), there was no difference in postoperative stay, abscess formation, readmission, or emergency room visits for simple or complex appendicitis. Operative time was significantly longer for cases of simple appendicitis by 10 min (p = <0.0001) and charges significantly higher by $600 (p = <0.0001) when a resident was involved in the case. These differences held true for complex appendicitis (time longer by 9 min, p = <0.0001 and charges higher by $500, p = 0.03).

Resident involvement results in an increase in operative time and charges, with no difference in length of stay or complications. These results highlight the cost of resident involvement, without an increase in complications experienced by patients.

Level III evidence.