COMMENTARY

Is It Safe to Have That Resident Do My Surgery?

Albert B. Lowenfels, MD

Disclosures

November 15, 2012

Impact of Resident Participation in Surgical Operations on Postoperative Outcomes: National Surgical Quality Improvement Program

Kiran RP, Ali UA, Coffey JC, Vogel JD, Pokala N, Fazio VW
Ann Surg. 2012;256:469-475

Summary

The aim of this study was to determine whether surgical participation by residents during an operation had any impact on morbidity and mortality. After careful matching of baseline patient characteristics, the authors compared 40,474 operative patients on whom residents participated in the procedure with 20,237 patients who had operations without resident participation. No differences in mortality or severe complications were found, but significant differences were observed in several other categories such as wound infection (3.0% vs 2.2%; P < .001) and operative duration (122 minutes vs 97 minutes; P < .001).

Viewpoint

About 80% of patients undergo surgery in hospitals with a surgical residency program, so it is gratifying that the results of this nationwide study show no increase in mortality or major complications. However, the increases in wound infection rate and other minor complications are disturbing, especially because reimbursement issues are involved. The cause is unclear. Could it simply be that more accurate ascertainments of infections and complications are made in teaching hospitals? Another possibility is a potential difference in patient characteristics because this was not a randomized trial. There is a clear need to train new surgeons. This report gives us information about the impact of training residents on overall patient care.

Abstract

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