Resident and Fellow Participation in Breast Surgery: An American College of Surgeons NSQIP Clinical Outcomes Analysis

Abstract

In our present health and medical education system, participation of residents and fellows is under increasing scrutiny regarding their role in surgery and the outcomes of the procedure. Our goal was to perform a clinical outcomes analysis investigating resident and fellow participation in breast surgery. Early postoperative complication rates and total operation times for partial and simple mastectomy cases were gathered from the ACS-NSQIP database. The cases were divided based on the training level of the participating resident surgeon: junior (post-graduate year [PGY] 1 to 2), senior (PGY 3 to 5), fellow (PGY > 5), as well as an attending only group (no resident present). We compared the clinical outcomes of each group with the attending only group. Statistical analysis included odds ratios and regression analysis that analyzed the correlation between years in training vs complication rate, and years in training vs total operation time. A total of 13,254 cases were identified, and residents participated in 64% of them. There was no statistically significant difference in rate of complications between any of the trainee groups when compared with the attending only group. However, total operative times were correlated with training year levels and found to be significantly lower with each year of training (R(2)= 0.53, p= 0.025 for partial mastectomy; R(2)= 0.45, p= 0.046 for complete mastectomy). Resident/fellow participation does not negatively affect early postoperative breast surgery outcomes, and complication rates are unrelated to the training level of the participating resident/fellow surgeon.