The impact of resident involvement on otolaryngology surgical outcomes

Laryngoscope. 2016 Mar;126(3):602-7. doi: 10.1002/lary.25046. Epub 2015 Nov 3.


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.

Keywords: 30-day complications; National Surgical Quality Improvement Program; Resident training; medical education; surgical outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Competence*
  • Cohort Studies
  • Education, Medical, Graduate / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Internship and Residency*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Otorhinolaryngologic Surgical Procedures / adverse effects
  • Otorhinolaryngologic Surgical Procedures / education*
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology*
  • Propensity Score
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • Treatment Outcome