Impact of Resident Involvement in Surgery (IRIS-NSQIP): Looking at the Bigger Picture Based on the American College of Surgeons-NSQIP Database

Abstract

Surgical residency training aims to prepare the surgical resident to become an independent practitioner of surgery. Because surgical residency training remains the sole educational channel to prepare surgeons for independent practice, our study aimed to explore the effect of resident involvement in surgery across a broad spectrum of surgical specialties to answer questions patients, surgeons, and surgical residency program directors may have concerning the effect of having residents participate in performing surgical operations. This analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to establish whether patients having operations involving residents were at a risk of postoperative mortality or morbidity similar to patients having operations performed by attending surgeons alone, across a wide array of surgical procedures. For operations in which residents were involved, the adjusted odds ratio (OR) for mortality was 0.93 (95% CI 0.90 to 0.97), as compared with the group of patients on whom attending surgeons operated alone without any level of resident involvement. For operations in which residents were involved, the adjusted OR for morbidity was 1.02 (95% CI 1.00 to 1.04), as compared with the group of patients on whom attending surgeons operated alone without any level of resident involvement. There was a slightly statistically significantly higher risk of cardiac and respiratory morbidities in the group with any level of resident involvement as compared with the "attending alone" group. Our study confirms that, across different surgical subspecialties, resident involvement in surgery is associated with comparable morbidity and lower mortality outcomes. This provides a reassuring answer to patients, attending surgeons, and surgical program directors.