Safety assessment of resident grade and supervision level during emergency appendectomy: analysis of a multicenter, prospective study. Surgery 2014 Jul;156(1):28-38
Date
06/03/2014Pubmed ID
24882763DOI
10.1016/j.surg.2014.04.007Scopus ID
2-s2.0-84902533623 (requires institutional sign-in at Scopus site) 38 CitationsAbstract
BACKGROUND: Resident surgeons have been identified as a risk factor for worse outcome after appendectomy. The context of grade of resident and impact of supervision require further investigation. The objective of this study was to determine whether grade and supervision level of resident-performed appendectomy affects patient outcome.
METHODS: A multicenter, prospective cohort study was performed for consecutive patients undergoing appendectomy during May and June 2013. The primary endpoint for this analysis was the 30-day adverse event rate. Supervision was defined as resident-performed appendectomy with an attending scrubbed. Multivariable binary logistic regression was used to take into account case mix and produce adjusted odds ratios (OR).
RESULTS: From 2,867 appendectomies, 87% were performed by residents, and 72% were performed unsupervised. Residents operated on significantly younger patients with lower American Society of Anesthesiologists scores. Although wound infection rates were similar between attendings, and senior and junior residents (4.1%, 3.8%, 3.4% respectively; P = .486), pelvic abscess rate was greater for attendings (5.2%, 2.7%, 2.4%; P = .045). In adjusted models, supervised senior, supervised junior, and unsupervised junior residents showed no difference in 30-day adverse event rates compared with attendings (OR, 1.07 [P = .834], 0.93 [P = .773], and 0.83 [P = .264] respectively); unsupervised senior residents had a lesser rate of adverse events (OR, 0.71; P = .045). All resident groups showed no difference for rates of histopathologically normal appendectomy compared with attendings.
CONCLUSION: Resident-performed appendectomy does not worsen patient outcomes. These findings support independent resident operating rights for selected cases. The system relies on mutual credentialing of competency between residents and supervising attendings.
Author List
Singh P, Turner EJ, Cornish J, Bhangu A, National Surgical Research CollaborativeMESH terms used to index this publication - Major topics in bold
Abdominal AbscessAdolescent
Adult
Aged
Aged, 80 and over
Appendectomy
Appendicitis
Child
Child, Preschool
Clinical Competence
Emergencies
Female
Follow-Up Studies
Humans
Infant
Internship and Residency
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications
Prospective Studies
Surgical Wound Infection
Treatment Outcome
Young Adult
