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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2013

01-11-2013 | Healthcare Policy and Outcomes

Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery

Authors: Anthony W. Castleberry, MD, MMCi, Bryan M. Clary, MD, John Migaly, MD, Mathias Worni, MD, MHS, Jeffrey M. Ferranti, MD, MS, Theodore N. Pappas, MD, John E. Scarborough, MD

Published in: Annals of Surgical Oncology | Issue 12/2013

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Abstract

Background

Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality.

Methods

A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005–2009. Colorectal, hepatopancreaticobiliary, and gastroesophageal oncology procedures were included. Multivariate logistic regression was used to assess the impact of trainee involvement on 30-day morbidity and mortality after adjusting for potential confounders.

Results

A total of 77,862 patients were included for analysis, 53,885 (69.2 %) involving surgical trainees and 23,977 (30.8 %) without trainees. The overall 30-day morbidity was significantly higher in the trainee group [27.2 vs. 21 %, adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.15–1.24, p < 0.0001)]; however, there was significantly lower 30-day postoperative mortality in the trainee group (1.9 vs. 2.1 %, AOR 0.87, 95 % CI 0.77–0.98, p = 0.02) and significantly lower failure-to-rescue rate (defined as mortality rate among patients suffering one or more postoperative complications) (5.9 vs. 7.6 %, AOR 0.79, 95 % CI 0.68–0.90, p = 0.001). The overall 30-day morbidity was highest in the PGY 5 level (29 %) compared to 24 % for PGY 1 or 2 and 23 % for PGY 3 (AOR per level increase 1.05, 95 % CI 1.03–1.07, p < 0.0001).

Conclusions

Trainee participation in complex, oncologic surgery is associated with significantly higher rates of 30-day postoperative complications in NSQIP-participating hospitals; however, this effect is countered by overall lower 30-day mortality and improved rescue rate in preventing death among patients suffering complications.
Literature
1.
Ludmerer KM. Time to heal: American medical education from the turn of the century to the era of managed care. New York: Oxford University Press, 2005.
2.
The Institute of Medicine (IOM). To err is human: building a safer health system. Washington: The National Academies Press, 1999.
3.
Argani CH, Eichelberger M, Deering S, Satin AJ. The case for simulation as part of a comprehensive patient safety program. Am J Obstet Gynecol 2012;206:451–5.PubMedCrossRef
4.
El Bardissi AW, Sundt TM. Human factors and operating room safety. Surg Clin North Am 2012;92:21–35.CrossRef
5.
Farnan JM, Petty LA, Georgitis E, Martin S, Chiu E, Prochaska M, et al. A systematic review: the effect of clinical supervision on patient and residency education outcomes. Acad Med 2012;87:428–42.PubMedCrossRef
6.
Graber ML, Wachter RM, Cassel CK. Bringing diagnosis into the quality and safety equations. JAMA 2012;308:1211–2.PubMedCrossRef
7.
Muething SE, Goudie A, Schoettker PJ, Donnelly LF, Goodfriend MA, Bracke TM, et al. Quality improvement initiative to reduce serious safety events and improve patient safety culture. Pediatrics 2012;130:e423–31.PubMedCrossRef
8.
Neeman N, Sehgal NL, Davis RB, Aronson MD. Quality improvement and patient safety activities in academic departments of medicine. Am J Med 2012;125:831–5.PubMedCrossRef
9.
Pronovost PJ, Bo-Linn GW. Preventing patient harms through systems of care. JAMA 2012;308:769–70.PubMedCrossRef
10.
Pronovost PJ, Weisfeldt ML. Science-based training in patient safety and quality. Ann Intern Med 2012;157:141–3.PubMed
11.
12.
Itani KMF, DePalma RG, Schifftner T, Sanders KM, Chang BK, Henderson WG, et al. Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals. Am J Surg 2005;190:725–31.PubMedCrossRef
13.
de Vries EN, Prins HA, Crolla RMPH, den Outer AJ, van Andel G, van Helden SH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010;363:1928–37.PubMedCrossRef
14.
Scarborough JE, Pappas TN, Cox MW, Bennett KM, Shortell CK. Surgical trainee participation during infrainguinal bypass grafting procedures is associated with increased early postoperative graft failure. J Vasc Surg 2012;55:715–20.PubMedCrossRef
15.
Scarborough JE, Bennett KM, Pappas TN. Defining the impact of resident participation on outcomes after appendectomy. Ann Surg 2012;255:577–82.PubMedCrossRef
16.
Patel SP, Gauger PG, Brown DL, Englesbe MJ, Cederna PS. Resident participation does not affect surgical outcomes, despite introduction of new techniques. J Am Coll Surg 2010;211:540–5.PubMedCrossRef
17.
Akingba DH, Deniseiko-Sanses TV, Melick CF, Ellerkmann RM, Matsuo K. Outcomes of hysterectomies performed by supervised residents vs those performed by attendings alone. Am J Obstet Gynecol 2008;199:673.e1–6.
18.
Morgan MK, Assaad NN, Davidson AS. How does the participation of a resident surgeon in procedures for small intracranial aneurysms impact patient outcome? J Neurosurg 2007;106:961–4.PubMedCrossRef
19.
Acun Z, Cihan A, Ulukent SC, Comert M, Ucan B, Cakmak GK, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;34:997–1001.PubMedCrossRef
20.
Ebner FH, Dimostheni A, Tatagiba MS, Roser F. Step-by-step education of the retrosigmoid approach leads to low approach-related morbidity through young residents. Acta Neurochir 2010;152:985–8; discussion 988.PubMedCrossRef
21.
Yap C-H, Andrianopoulos N, Dinh TD, Billah B, Rosalion A, Smith JA, et al. Short- and midterm outcomes of coronary artery bypass surgery performed by surgeons in training. J Thorac Cardiovasc Surg 2009;137:1088–92.PubMedCrossRef
22.
Shaked A, Calderom I, Durst A. Safety of surgical procedures performed by residents. Arch Surg 1991;126:559–60.PubMedCrossRef
23.
Shabtai M, Rosin D, Zmora O, Munz Y, Scarlat A, Shabtai EL, et al. The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident’s laparoscopic skills. Surg Endosc 2004;18:1328–30.PubMedCrossRef
24.
Emre AU, Cakmak GK, Tascilar O, Ucan BH, Irkorucu O, Karakaya K, et al. Complications of total thyroidectomy performed by surgical residents versus specialist surgeons. Surg Today 2008;38:879–85.PubMedCrossRef
25.
Kauvar DS, Braswell A, Brown BD, Harnisch M. Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy. J Surg Res 2006;132:159–63.PubMedCrossRef
26.
Doerr RJ, Yildiz I, Flint LM. Pancreaticoduodenectomy. University experience and resident education. Arch Surg 1990;125:463–5.PubMedCrossRef
27.
Poteet S, Tarpley M, Tarpley JL, Pearson AS. Veterans affairs general surgery service: the last bastion of integrated specialty care. Am J Surg 2011;202:507–10.PubMedCrossRef
28.
Chang Y-J, Mittal VK. Hepato-pancreato-biliary training in general surgery residency: is it enough for the real world? Am J Surg 2009;197:291–5.PubMedCrossRef
29.
30.
Tseng WH, Jin L, Canter RJ, Martinez SR, Khatri VP, Gauvin J, et al. Surgical resident involvement is safe for common elective general surgery procedures. J Am Coll Surg 2011;213:19–26; discussion 26–8.PubMedCrossRef
31.
Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 1998;228:491–507.PubMedCrossRef
32.
Fink AS, Campbell DA, Mentzer RM, Henderson WG, Daley J, Bannister J, et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg 2002;236:344–53; discussion 353–4.PubMedCrossRef
33.
Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care 1992;30:615–29.PubMedCrossRef
34.
Makary MA, Sexton JB, Freischlag JA, Millman EA, Pryor D, Holzmueller C, et al. Patient safety in surgery. Ann Surg 2006;243:628–32; discussion 632–5.PubMedCrossRef
35.
McCafferty MH, Polk HC. Patient safety and quality in surgery. Surg Clin North Am 2007;87:867–81.PubMedCrossRef
36.
Wachter RM. The end of the beginning: patient safety five years after “to err is human.” Health Aff (Project Hope) 2004;(Suppl Web):W4-534–45.
37.
Fallon WF, Wears RL, Tepas JJ. Resident supervision in the operating room: does this impact on outcome? J Trauma 1993;35:556–60; discussion 560–1.PubMedCrossRef
38.
Wilkiemeyer M, Pappas TN, Giobbie-Hurder A, Itani KMF, Jonasson O, Neumayer LA. Does resident post graduate year influence the outcomes of inguinal hernia repair? Ann Surg 2005;241:879–82; discussion 882–4.PubMedCrossRef
39.
The Institute of Medicine (IOM). Resident duty hours: enhancing sleep, supervision, and safety. Washington, DC: The National Academies Press, 2008.
40.
Lewis FR. Comment of the American Board of Surgery on the recommendations of the Institute of Medicine Report, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.” Surgery 2009;146:410–9.PubMedCrossRef
41.
Britt LD, Sachdeva AK, Healy GB, Whalen TV, Blair PG. Resident duty hours in surgery for ensuring patient safety, providing optimum resident education and training, and promoting resident well-being: a response from the American College of Surgeons to the Report of the Institute of Medicine, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety”. Surgery 2009;146:398–409.PubMedCrossRef
42.
Borman KR, Fuhrman GM. “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety”: response of the Association of Program Directors in Surgery to the December 2008 Report of the Institute of Medicine. Surgery 2009;146:420–7.PubMedCrossRef
43.
Tran J, Lewis R, de Virgilio C. The effect of the 80-h work week on general surgery resident operative case volume. Am Surg 2006;72:924–8.PubMed
44.
Carlin AM, Gasevic E, Shepard AD. Effect of the 80-hour work week on resident operative experience in general surgery. Am J Surg 2007;193:326–9; discussion 329–30.PubMedCrossRef
45.
Vanderveen K, Chen M, Scherer L. Effects of resident duty-hours restrictions on surgical and nonsurgical teaching faculty. Arch Surg 2007;142:759–64; discussion 764–6.PubMedCrossRef
46.
Chung RS: How much time do surgical residents need to learn operative surgery? Am J Surg 2005;190:351–3.PubMedCrossRef
47.
Damadi A, Davis AT, Saxe A, Apelgren K. ACGME duty-hour restrictions decrease resident operative volume: a 5-year comparison at an ACGME-accredited university general surgery residency. J Surg Educ 2007 64:256–9.PubMedCrossRef
48.
Beyer L, Troyer JD, Mancini J, Bladou F, Berdah SV, Karsenty G. Impact of laparoscopy simulator training on the technical skills of future surgeons in the operating room: a prospective study. Am J Surg 2011;202:265–72.PubMedCrossRef
49.
Zendejas B, Cook DA, Bingener J, Huebner M, Dunn WF, Sarr MG, et al. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg 2011;254:502–9; discussion 509–11.PubMedCrossRef
50.
Baker CJ, Sinha R, Sullivan ME. Development of a cardiac surgery simulation curriculum: from needs assessment results to practical implementation. J Thorac Cardiovasc Surg 2012;144:7–16.PubMedCrossRef
51.
52.
Silverman E, Dunkin BJ, Todd SR, Turner K, Fahy BN, Sukumaran A, et al. Nonsurgical airway management training for surgeons. J Surg Educ 65:101–8.
53.
Bismuth J, Donovan MA, O’Malley MK, El Sayed HF, Naoum JJ, Peden EK, et al. Incorporating simulation in vascular surgery education. J Vasc Surg 2010;52:1072–80.PubMedCrossRef
54.
Aggarwal R, Darzi A. Innovation in surgical education: a driver for change. Surgeon 2011;9(Suppl 1):S30–1.PubMedCrossRef
55.
Dimick JB, Cowan JA, Colletti LM, Upchurch GR. Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg 2004;139:137–41.PubMedCrossRef
56.
Meguid RA, Brooke BS, Chang DC, Sherwood JT, Brock MV, Yang SC. Are surgical outcomes for lung cancer resections improved at teaching hospitals? Ann Thorac Surg 2008;85:1015–24; discussion 1024–5.
57.
Kupersmith J. Quality of care in teaching hospitals: a literature review. Acad Med 2005;80:458–66.PubMedCrossRef
58.
Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009;361:1368–75.PubMedCrossRef
59.
Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg 2010;211:325–30.PubMedCrossRef
60.
Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 2009;250:1029–34.PubMedCrossRef
Metadata
Title
Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery
Authors
Anthony W. Castleberry, MD, MMCi
Bryan M. Clary, MD
John Migaly, MD
Mathias Worni, MD, MHS
Jeffrey M. Ferranti, MD, MS
Theodore N. Pappas, MD
John E. Scarborough, MD
Publication date
01-11-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 12/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3079-2

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