N. R. Changoor1, G. Ortega1, E. E. Cornwell1, A. H. Haider2 1Howard University Hospital,Department Of Surgery,Washington, DC, USA 2Center For Surgical Trials And Outcomes Research (CSTOR),Department Of Surgery,Baltimore, MD, USA
Introduction:
Studies have demonstrated racial disparities among surgical outcomes. Contributing factors to these disparities have been evaluated at the system, provider and patient levels. Few studies have examined the role of surgical residents. This study aims to elucidate if racial disparities exist in case selection and surgical outcomes by resident surgeons using a national database.
Methods:
A retrospective analysis of the ACS-NSQIP database from 2005-2010 was conducted. Procedures selected for analysis were laparoscopic cholecystectomy, laparoscopic appendectomy and open hernia repair. Demographic, pre-operative co-morbidities, level of resident surgeon, as well as post-operative complications were analyzed. Residents were grouped into junior level (PGY 1- 2), upper level/senior residents and attending alone (PGY 0). Descriptive statistics and multivariate analysis were conducted to assess case selection by level of training and surgical outcomes adjusting for age, gender, race, co-morbidities, and wound classification.
Results:
We identified 196,770 patients with a median age of 47, majority (51.3%) were females with the commonest procedure being laparoscopic cholecystectomy (47.4%). The majority were White patients at 74%, followed by Black, 9.2% and Hispanic 12.2%. Attendings alone performed 43% of cases, lower level residents 20.1%, then upper level residents 37.5%. Comparing Race and level of surgeon, attending alone operated on 44.1% White, 30.1% Black and 43.9% Hispanic; upper level/senior residents operated on 35.5% White, 48.7% Black and 41.34% Hispanic; lower level residents operated on 20.4%% White, 21.3% Black and 14.8% Hispanic. Black patients had a higher complication rate than white patients. (See Figure 1) On adjusted analysis, Black patients were more likely to have wound infections (OR 1.15, CI: 1.02-1.30), major complications (OR 1.39, CI: 1.27-1.53) and minor complications (OR 1.08, CI: 0.95 – 1.22). When compared to the attending alone, upper level/senior residents were more likely to operate on black patients (OR 2.02, CI: 1.95-2.09) and were more likely to have wound infections (OR 1.3, CI:1.19-1.39), major complications (OR 1.1, CI: 1.06-1.21) and minor complications (OR 1.2, CI:1.11-1.31).
Conclusion:
Our study demonstrates that there is an association between resident level training and surgical outcomes in minority patients. Upper level/senior residents were more likely to operate on Black patients and these residents who may have a more active role in the operation were more likely to have wound infections, major and minor complications. These two findings suggest that black patients have worse outcomes as a result of more independent operating upper level/senior residents.
