A 15-Year Analysis of Surgical Resident Operative Autonomy Across All Surgical Specialties in Veterans Affairs Hospitals

Abstract

Discussion | To our knowledge, this is the largest study investigating the association of MD with IBTR and contralateral breast cancer in patients who underwent breast-conserving surgery. The data show an association between high MD and the risk of contralateral breast cancer, especially in young patients with breast cancer. In contrast, the risk of IBTR was not affected by the degree of MD. These findings suggest that the degree of MD is not a relevant factor to consider when deciding the types of local treatment in patients with early breast cancer. Rather, the degree of MD can be used for the personalized surveillance approach because high MD is associated with an increased risk of contralateral breast cancer. The limitations of this study include its retrospective nature and the lack of patients of different races and ethnicities.

Association Between Operative Autonomy of Surgical Residents and Patient Outcomes

“…In addition, no difference in the resident plus surgeon vs residentprimary groups was observed in the rate of return to the operating room (8453 patients [6.1%] vs 8278 patients [6.0%]; OR, 0.98 [95% CI, 0.95-1.01]; P = . 16). Similar to the comparison between surgeon-primary vs resident-primary groups, no significant difference in complications was found between patients in the surgeon plus resident vs resident-primary groups, with the exception of postoperative bleeding of more than 4 U (200 patients [0.1%] vs 121 patients [0.1%]; OR, 0.60 [95% CI, 0.48-0.76]; P < .001) and inability to remove mechanical ventilation more than 48 hours after the operation (1071 patients [0.8%] vs 908 patients [0.7%]; OR, 0.85 [95% CI, 0.77-0.93]; P < .001), which was more frequent in resident plus surgeon cases (Table 4).…”

“…15 Although this increase was important, it was not necessarily associated with an increase in procedures performed by residents alone. 16 It would be preferable if the American Board of Surgery specifically stipulated that, for a surgical procedure to be considered a teaching assistant case, the attending surgeon would not be scrubbed for substantial portions of the procedure, if not the entire procedure.…”

Variation in Resident Operative Autonomy at Veterans Affairs Hospitals

“…International medical graduates (IMGs) represent 16% of general surgery residents. 1 Mistreatment is common in general surgical training, particularly for non-White or Hispanic residents, and is associated with burnout. 2 We assessed whether mistreatment and wellness differ between IMGs and US medical graduates in a national sample of general surgery residents.…”

“…Resident operative autonomy has decreased steadily. 1,2 Thus, concerns about surgical training quality and trainee readiness for practice have increased. 3 The degree of institutional variation in resident operative autonomy and the extent to which varying institutional practices might alter postoperative outcomes are unclear.…”

“…The latter 2 categories were defined as RP cases. 1 Hospitals were stratified into resident operative autonomy quintiles of reliability-adjusted RP rates (very low, low, medium, high, and very high), controlling for patient frailty using the Risk Analysis Index, procedural complexity, surgical specialty, and resident postgraduate year. 4 Associations between hospital quintiles and perioperative complications, major complications, multiple complica- tions, 30-day mortality, and failure to rescue (FTR) were evaluated with multivariable hierarchical regression.…”