Does resident autonomy in colectomy procedures result in inferior clinical outcomes?

Tonelli, Celsa; Lorenzo, Isabela; Bunn, Corinne; Kulshrestha, Sujay; Agnew, Sonya P.; Abdelsattar, Zaid M.; Luchette, Frederick A; Baker, Marshall S.

doi:10.1016/j.surg.2021.09.036

Cited by 11 publications

(4 citation statements)

References 11 publications

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“…Prior analyses of resident autonomy have either focused on a single procedure or include a wide variety of procedures with low case complexity. [8][9][10][11][12][13] The most notable is a recent paper using VA data to evaluate the association between resident autonomy and clinical outcome for the most common procedures performed within the VA health care system. 6 This study included cases from multiple specialties and found that resident autonomy did not result in increased mortality or morbidity.…”

Section: Discussionmentioning

confidence: 99%

Association of Resident Independence With Short-term Clinical Outcome in Core General Surgery Procedures

et al. 2023

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ImportancePrior studies evaluating the effect of resident independence on operative outcome draw from case mixes that cross disciplines and overrepresent cases with low complexity. The association between resident independence and clinical outcome in core general surgical procedures is not well defined.ObjectiveTo evaluate the level of autonomy provided to residents during their training, trends in resident independence over time, and the association between resident independence in the operating room and clinical outcome.Design, Setting, and ParticipantsUsing the Veterans Affairs Surgical Quality Improvement Program database from 2005 to 2021, outcomes in resident autonomy were compared using multivariable logistic regression and propensity score matching. Data on patients undergoing appendectomy, cholecystectomy, partial colectomy, inguinal hernia, and small-bowel resection in a procedure with a resident physician involved were included.ExposuresResident independence was graded as the attending surgeon scrubbed into the operation (AS) or the attending surgeon did not scrub (ANS).Main Outcomes and MeasuresOutcomes of interest included rates of postoperative complication, severity of complications, and death.ResultsOf 109 707 patients who met inclusion criteria, 11 181 (10%) underwent operations completed with ANS (mean [SD] age of patients, 61 [14] years; 10 527 [94%] male) and 98 526 (90%) operations completed with AS (mean [SD] age of patients, 63 [13] years; 93 081 [94%] male). Appendectomy (1112 [17%]), cholecystectomy (3185 [11%]), and inguinal hernia (5412 [13%]) were more often performed with ANS than small-bowel resection (527 [6%]) and colectomy (945 [4%]). On multivariable logistic regression adjusting for procedure type, age, body mass index, functional status, comorbidities, American Society of Anesthesiologists class, wound class, case priority, admission status, facility type, and year, factors associated with a complication included increasing age (adjusted odds ratio [aOR], 1.19 [95% CI, 1.16-1.22]), emergent case priority (aOR, 1.41 [95% CI, 1.33-1.50]), and resident independence (aOR, 1.12 [95% CI, 1.03-1.22]). On propensity score matching, AS cases were score matched 1:1 to ANS cases based on the variables listed above. Comparing matched cohorts, there was no difference in complication rates (817 [7%] vs 784 [7%]) or death (91 [1%] vs 102 [1%]) based on attending physician involvement.Conclusions and RelevanceCore general surgery cases performed by senior-level trainees in such a way that the attending physician is not scrubbed into the case are being done safely with no significant difference in rates of postoperative complication.

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Section: Discussionmentioning

confidence: 99%

Association of Resident Independence With Short-term Clinical Outcome in Core General Surgery Procedures

et al. 2023

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“…17 Other studies have also shown no increase in morbidity or 30-day mortality when examining resident autonomy cases versus cases in which the attending scrubbed looking at general surgical procedures. 3,19,[25][26][27][28] Unfortunately, despite having higher rates of resident autonomy during off-hours, it has declined in parallel with daytime surgeries over the 15-year duration of the study. Many factors have been cited in the literature for resident trainees not being entrusted with operative autonomy.…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated across all surgical specialties, with propensity score–matched analysis of 238,879 total cases, that RP cases showed no increase in morbidity or 30-day mortality between RP and AR cases or RP and AP cases 17 . Other studies have also shown no increase in morbidity or 30-day mortality when examining resident autonomy cases versus cases in which the attending scrubbed looking at general surgical procedures 3,19,25–28 …”

Section: Discussionmentioning

confidence: 99%

Surgical resident operative autonomy on nights and weekends: What happens to surgical education during off-hours?

Anjaria

Oliver

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:Surgical resident operative autonomy is critical for trainee maturation to independence. Acute care surgery (ACS) cases commonly occur off-hours and tension between operating room availability and on-call staff can affect resident operative autonomy. We examined operative resident autonomy for general, vascular, and thoracic (GVT) surgery during nights and weekends. We hypothesized that residents would be afforded less operative autonomy during off-hours than weekdays. METHODS:This retrospective cohort study uses the Veterans Affairs Surgical Quality Improvement Program database, we examined all GVT cases at Veterans Affairs teaching hospitals from 2004 to 2019. All cases are coded for the level of supervision at the time of surgery: AP, attending primary surgeon; AR, attending and resident operating together; and RP, resident primary (attending supervising but not scrubbed). Cases starting between 6 PM to 7 AM Monday through Friday were considered nights, cases on Saturday/Sunday were considered weekends, and collectively considered "off-hours." Resident primary case rates were compared by start time and type. RESULTS:Over the 15-year study period, there were 666,421 GVT cases performed with 38,097 cases (6%) performed offhours. During off-hours, 31,396 (83%) were ACS compared with 5% of daytime cases. Overall, off-hours cases have higher RP rate than daytime cases (6.8% vs. 5.8%, p < 0.001). Daytime ACS cases have higher rates of RP than nights/weekends (7.6% vs. 6.8%, p < 0.001). Conversely, daytime elective cases have lower RP than nights (5.7% vs. 7.9%, p < 0.001). During off-hours, there are more RP cases on nights compared with weekends (7.1% vs. 6.5%, p = 0.02). CONCLUSION:Overall, residents were afforded more operative autonomy during off-hours, with nights having greater RP than weekends. In contrast, ACS cases have more autonomy during weekdays. These data have potentially significant implications for ACS service staffing, night float rotations, and overall resident operative experience on ACS services.

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“…O componente idade foi decisivo para a ocorrência de complicações no pósoperatório de cirurgia de correção de fratura de fêmur. Para cada aumento de um ano na idade, a razão de chance vir a óbito aumenta em 28% (Tonelli et al, 2022).…”

Section: Estudo Prospectivounclassified

Complicações pós-cirúrgicas em pacientes idosos: revisão integrativa de literatura

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Pena

Silva

et al. 2022

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ResumoObjetivo: O objetivo deste estudo é identificar e analisar as produções científicas na literatura mundial sobre complicações no pós-operatório em pacientes idosos. Método: Trata-se de uma revisão integrativa da literatura cuja busca de dados foi realizada em diferentes bases de dados utilizando os descritores "Health of the Elderly", "Perioperative Care", "Postoperative Complications", "Patient Care" nas bases de dados eletrônicas: Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) via via Biblioteca Virtual de Saúde (BVS). Scientific Eletronic Library Online (SciELO), Web of Science (WOS), Cinahl e Scopus via Portal de Periódicos CAPES e Cochrane Library. Resultados e Discussão: Identificou-se, um total de 938 estudos nas referidas bases de dados. Sendo 163 Medline, 86 no LILACS, 73 na SciELO, 296 na base de dados Scopus, 208 no Web of Science, 54 na base da Cochrane Library e 58 na CINAHL, após critérios de exclusão a amostra final foi 13 artigos. Complicações foram observadas em diversas especialidades cirúrgicas, sendo a fragilidade na saúde do idoso um potencial para complicações e aumento do tempo de internação hospitalar. Conclusão: O fator "idade" predispõe às complicações no perioperatório. Foram observadas complicações em várias especialidades cirúrgicas, sendo a fragilidade na saúde do idoso o potencial para complicações e aumento do tempo de internação hospitalar. Procedimentos invasivos e de longa duração está sendo realizados cada vez mais em idosos. O controle e vigilância da anestesia e os protocolos hospitalares são de grande utilidade nessa fase. Palavras-chave: Complicações pós-operatórias; Assistência perioperatória; Assistência ao paciente; Saúde do idoso.

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Does resident autonomy in colectomy procedures result in inferior clinical outcomes?

Cited by 11 publications

References 11 publications

Association of Resident Independence With Short-term Clinical Outcome in Core General Surgery Procedures

Association of Resident Independence With Short-term Clinical Outcome in Core General Surgery Procedures

Surgical resident operative autonomy on nights and weekends: What happens to surgical education during off-hours?

Complicações pós-cirúrgicas em pacientes idosos: revisão integrativa de literatura

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