Purpose To define trends in resident supervision in the Veterans Affairs Healthcare system during appendectomies and compare surgical outcomes between resident independent and non-independent appendectomies. Methods 18,128 appendectomies from fiscal year 2000-2020 were obtained from the VASQIP database. Cases were divided based on whether the attending was scrubbed for the procedure. Of the remaining 18,128 cases, the attending was noted not to be scrubbed in 786 of them. The frequency of residents operating without an attending scrubbed was trended by year. Comorbidities and outcomes were examined. All data were examined using c2, Student t test*, and Fisher's exact test within SPSS version 26. Results Significantly more cases were performed without the attending scrubbed before 2003 (23.3% vs 2.2%, p < 0.001). In cases without the attending scrubbed, residents were more likely to perform an open procedure (67.9% vs 32.1%, p < 0.001) and operate emergently (76.1% vs. 63.8%, p < 0.001). No difference existed when residents operated independently between 30 day mortality (0.8% vs. 0.5%, p = 0.329), Operative time (1.29 h ± 1.11 vs. 1.29 h ± 1.00, p = 0.928), units of blood transfused (0.01 ± 0.128 vs. 0.01 ± 0.159, p = 0.656) or complication rate (10.7% vs. 9.2%, p = 0.162). Conclusion Our analysis of the VASQIP database demonstrates that resident independent operating in appendectomy has declined tenfold since the early 2000s. Residents independently performing appendectomy had no clinically significant impact on patient outcomes. Higher rates of open appendectomy in the resident cohort likely reflect the majority of resident independent cases being in the early 2000s.
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