Background
Despite recognition of racial/ethnic surgical disparities, few studies have considered
the role of surgical residents. This study aimed to elucidate whether disparities
in postoperative outcomes are associated with the presence/level of surgical residents
involved in procedures.
Methods
Patients who were classified as having laparoscopic cholecystectomy, laparoscopic
appendectomy, and open hernia repair in the 2005−2010 American College of Surgeons
National Surgical Quality Improvement Program database were compared by level of provider
(junior residents postgraduate year 1–2, senior residents, attending alone) for differences
in patient demographics, clinical case-mix, and postoperative outcome information
by the use of descriptive statistics and multivariable logistic regression.
Results
A total of 196,770 patients met inclusion criteria. Attendings performed 43.0% of
operations alone (senior residents 37.5%, junior residents 20.1%), They operated on
44.1% white, 30.1% black, and 43.9% Hispanic patients compared with 35.5%, 48.7%,
and 41.3% and 20.4%, 21.3%, and 14.8% for senior and junior residents, respectively.
Compared with attendings alone, senior residents were more likely to operate on black
patients (adjusted odds ratio [OR] 2.02, 95% confidence interval [95% CI] 1.95–2.09)
and have major (OR 1.13, 95% CI 1.06–1.21) and minor complications (OR 1.20, 95% CI
1.11–1.31). Junior residents also were more likely to operate on black patients but
did not experience significantly worse outcomes.
Conclusion
Greater risk-adjusted odds of complications among patients treated by senior residents
need to be carefully weighed given the group's higher likelihood of operating on minority
patients.
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Article info
Publication history
Published online: May 20, 2015
Accepted:
March 14,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
