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The impact of resident involvement on otolaryngology surgical outcomes
Author(s) -
Vieira Brittany L.,
Hernandez David J.,
Qin Charles,
Smith Stephanie S.,
Kim John Y. S.,
Dutra Jose C.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25046
Subject(s) - medicine , logistic regression , otorhinolaryngology , cohort , retrospective cohort study , odds ratio , propensity score matching , cohort study , odds , emergency medicine , surgery
Objectives/Hypothesis Intraoperative experience is an essential element of surgical training, but has the potential to impact patient outcomes. The purpose of this study was two‐fold: 1) to evaluate the effect of resident involvement on morbidity and mortality following otolaryngology procedures and 2) to examine the influence of resident training level on the same outcomes. Study Design Retrospective cohort study. Methods This study reviewed 2,320,920 patients captured in the 2005 to 2012 National Surgical Quality Improvement Program databases to identify surgical otolaryngology cases. Outcomes of interest included surgical complications, medical complications, and mortality. Cases with and without resident involvement were propensity matched (caliper = 0.2) to account for nonrandomized assignment, and data were subject to multivariate logistic regression analyses. Results Residents participated in 38.4% of the 20,307 cases identified. Cases with resident involvement demonstrated longer operative duration (178.8 minutes vs. 80.1 minutes, P < .001), increased surgical complexity (23.5 relative value units [RVU] vs. 12.4 RVU, P < .001) and greater overall morbidity burden. Logistic regression analyses of the matched cohort revealed that resident participation did not independently increase morbidity (odds ratio [OR] = 0.969, P = .751) or mortality (OR = 0.893, P = .758). A separate logistic regression analysis of the unmatched cohort using resident postgraduate year showed that training level did not confer differential risk to patients. Conclusions Our data indicate that resident involvement does not increase the risk of morbidity or mortality, and that trainees are being assigned to appropriate cases for their level of experience. These findings suggest that the contemporary paradigm of graduate otolaryngology surgical education does not negatively impact patient outcomes. Level of Evidence 2c Laryngoscope , 126:602–607, 2016