Outcomes associated with resident involvement in partial colectomy

Abstract

Background: Surgical cases that include trainees are associated with worse outcomes in comparison with those that include attending surgeons alone.

Objective: This study aimed to identify whether resident involvement in partial colectomy was associated with worse outcomes when evaluated by surgical approach and resident experience.

Design: This is a retrospective study using the National Surgical Quality Improvement Program database.

Settings: This study evaluates cases included in the National Surgical Quality Improvement Program database.

Patients: All patients were included who underwent partial colectomy including both open and laparoscopic approaches.

Interventions: Residents were involved.

Main outcome measures: The primary outcome measures were the association of resident involvement and major complication events, minor complication events, unplanned return to operating room, and operative time.

Results: Cases with residents were associated with major complications (OR 1.18, CI 1.09-1.27, p < 0.001) on multivariate analysis. However, after including operative time in the model only open cases involving fifth year residents were still associated with major complications (OR 1.13, p = 0.037). Resident involvement was associated with increased likelihood of minor complications (OR 1.3, p < 0.001) and an increased risk of unplanned return to the operating room (OR 1.20, p < 0.001). Operative time was longer for cases with residents on average by 33.7 minutes and 27 minutes for open and laparoscopic cases.

Limitations: This study was limited by its retrospective design and lack of data on teachings status, case complexity, and intraoperative evaluation of technique.

Conclusions: Resident involvement in partial colectomies is associated with an increased major complications, minor complications, likelihood of return to the operating room, and operative time.