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Outcomes Associated With Resident Involvement in Partial Colectomy

Iannuzzi, James C. M.D.; Rickles, Aaron S. M.D.; Deeb, Andrew-Paul B.S.; Sharma, Abhiram M.D.; Fleming, Fergal J. M.D., F.R.C.S.; Monson, John R. T. M.D., F.R.C.S.

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e318276862f
Original Contribution: Benign Colorectal Disease
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.

Author Information

Surgical Health Outcomes & Research Enterprise, University of Rochester Medical Center, Rochester, New York

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: James Iannuzzi, M.D., Research Fellow, Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester, 601 Elmwood Ave, Box Surg, Rochester, NY 14642. E-mail: james_iannuzzi@urmc.rochester.edu

© The ASCRS 2013