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The Association Between Trainee Operative Autonomy and Perioperative Complications in Breast Surgery.

Sarah W Yuen1, Nicole Finney2, Shaina Sedighim1

  • 1Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Orange, California.

The Journal of Surgical Research
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Summary
This summary is machine-generated.

Resident autonomy in breast surgery is linked to fewer complications and no increase in mortality. This study found that increased trainee involvement in procedures did not negatively impact patient outcomes, despite higher-risk cases.

Keywords:
AutonomyBreast surgeryResidentSurgical educationTrainee

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Area of Science:

  • Surgical Education
  • Patient Safety
  • Breast Surgery Outcomes

Background:

  • Decreasing operative independence for surgical residents impacts training and future practice readiness.
  • Assessing the link between trainee autonomy and patient outcomes in breast surgery is crucial.

Purpose of the Study:

  • To evaluate the association between resident operative autonomy and perioperative complications in breast surgery.
  • To determine if increased trainee involvement correlates with adverse patient events or mortality.

Main Methods:

  • Utilized the 2005-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.
  • Stratified breast surgery cases into attending primary (AP), resident supervised (RS), and resident primary (RP) involvement.
  • Analyzed wound complications, length of stay, major complications, and 30-day mortality using regression analyses.

Main Results:

  • Resident primary (RP) cases involved older patients with higher ASA class and more axillary lymphadenectomies.
  • Operative time increased with resident autonomy, but length of stay decreased.
  • Resident primary cases showed the lowest wound complication rates; no significant differences in major complications or mortality were observed across groups.

Conclusions:

  • Trainee operative autonomy in breast surgery is associated with low complication and mortality rates.
  • Despite managing higher-risk patients and procedures, resident autonomy did not increase morbidity or mortality.
  • Further research is needed to clarify the impact of trainee autonomy on oncologic outcomes.