Independent Operating by General Surgery Residents: An ACS-NSQIP Analysis

J Surg Educ. 2021 Apr 17;S1931-7204(21)00069-6. doi: 10.1016/j.jsurg.2021.03.016. Online ahead of print.

Abstract

Objective: Surgical resident autonomy during training is paramount to independent practice. We sought to determine prevalence of general surgery resident autonomy for surgeries commonly performed on emergency general surgery services and identify trends with time.

Design: We queried ACS-NSQIP for patients undergoing one of 7 emergency general surgery operations. We evaluated trends in independent operating (defined as a resident operating alone, without attending having scrubbed) over the study period. Other outcomes of interest: operative time, 30-day-mortality and complications.

Setting: The ACS-NSQIP database.

Participants: Patients undergoing one of 7 emergency general surgery operations.

Results: Data regarding resident involvement was only available for the years 2005-2010. 90,790 operations were performed, 922 (1%) by residents operating independently. Appendectomy accounted for 61% independent cases. Independent resident operating was associated with a longer operative time (65 versus 58 minutes, p < 0.001), but lower risk of bleeding requiring transfusion (p < 0.001) and progressive renal insufficiency (p = 0.02). Independent operating was not associated with increased risk of complications/mortality.

Conclusion: Independent resident operating is rare, even with increasing attention to its importance, and is not associated with increased complications or mortality. National data on this subject is old and not currently collected. There is need for a national registry on resident involvement to understand the current effect of independent operating on outcomes.

Keywords: Autonomy; Competence; Emergency general surgery; Patient safety; Surgical training.