M. Zeeshan1, M. Hamidi1, A. Tang1, E. Zakaria1, N. Kulvatunyou1, A. Jain1, L. Gries1, T. O’Keeffe1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA
Introduction:
Diverticular disease is one of the leading causes for outpatient visits and hospitalizations. Resident participation in surgical procedures is essential for training. However, there is paucity of data regarding the outcomes after resident involvement in surgical procedures for diverticulitis. The aim of our study was to determine if the resident participation in surgery correlates with outcomes for patients undergoing surgical procedures in diverticulitis.
Methods:
We analyzed the National Surgical Quality Improvement Program database (2005-2012). We included all patients who had diagnosis of diverticular disease and underwent surgical management. Patients were stratified into two groups based on presence of resident during surgery: attending alone (No-RES) vs. attending with resident (RES). Groups were matched using propensity score matching for demographics, surgical procedure, morbidity probability and comorbidities. Outcomes of interest were compared for patients with and without resident participation in surgery (RES vs no-RES). We performed a sub-analysis of RES group by dividing it into junior (PGY 1-3), and senior residents (PGY 4-5), and fellows (PGY ≥ 6).
Results:
26,172 patients met the inclusion criteria, of which 6912 (3456: No-RES, 3456: RES) were matched. Mean age was 58.8 ± 14.3 years, and 46.7% were males. There was no difference in mortality in both groups (p=0.58), however, overall 30-d complication rates were higher in RES group (18% vs. 15.1%, p<0.01). Operative time (OR time) was longer in the RES group (175 min vs. 142 min, p<0.01), while there was no difference of hospital length of stay (HLOS) between the two groups (p=0.17). Table 1 shows the sub analysis based on level of residency. Mortality rate was highest in senior residents (p<0.01), while operative time was highest in operation performed by fellows (p<0.01).
Conclusion:
Resident involvement in surgical management of diverticulitis increases the rate of complications without an increase in mortality. Resident involvement is an important component of surgical residency. Identifying the factors and increased supervision by attendings may lead to improved outcomes.
