Evaluating the Impact of Surgical Residents on Hospital Quality and Operational Metrics

Abstract

Objective: The purpose of this study is to conduct a follow up analysis comparing operational and quality measures of the pre-residency period with those of a mature program comprised of a full cohort of 15 residents, with 3 residents in each post graduate year (PGY) 1-5.

Design: A retrospective review of 25,900 surgeries performed by the general, breast, plastics, thoracic, and vascular services at a single regional medical center was performed and surgeries were classified as pre-residency period and residency period. Independent variables included patient demographics, comorbidity burden, emergency department arrivals, and outcomes of interest included daily elective case volume, the percent of cases performed during 'off-hours' (defined as 7p-7a), operating room (OR) and procedure minutes, average length of stay (LOS), average total hospital charges, rates of 30-day return to OR (ROR), ED visits, and readmissions, and patient satisfaction. Univariate and multivariate analysis performed to compare pre-residency period outcomes with residency period outcomes.

Setting: Luminis Health Anne Arundel Medical Center, Annapolis, Maryland, a community hospital and tertiary care center, home to 3 graduate medical education programs.

Participants: 25,900 surgical cases performed by the general, breast, plastics, thoracic, and vascular services.

Results: 25,900 surgeries reviewed and with a full complement of residents the odds of cases being performed off hours increased by 14.5%, odds of 30-day return to the OR decreased by 23.9%, and odds of 30-day readmission decreased by 17.1%. Additionally, length of stay was decreased by ½ day. OR time and procedure time both increased after the addition of a full resident complement. All of these findings were of statistical significance.

Conclusions: Surgical residents appear to enhance the value of surgical care delivered to patients by improving outcomes without increasing costs, as well as improving the availability of emergency surgical care.

Keywords: clinical outcomes; graduate medical education; residency program evaluation; resident productivity; resident value; surgical education; surgical training.