Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality?
OBJECTIVES/HYPOTHESIS
Patients may perceive resident procedural participation as detrimental to their outcome. Our objective is to investigate whether otolaryngology-head and neck surgery (OHNS) housestaff participation is associated with surgical morbidity and mortality.


STUDY DESIGN
Case-control study.


METHODS
OHNS patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program 2006 to 2013 databases. We compared the incidence of 30-day postoperative morbidity, mortality, readmissions, and reoperations in patients operated on by resident surgeons with attending supervision (AR) with patients operated on by an attending surgeon alone (AO) using cross-tabulations and multivariable regression.


RESULTS
There were 27,018 cases with primary surgeon data available, with 9,511 AR cases and 17,507 AO cases. Overall, 3.62% of patients experienced at least one postoperative complication. The AR cohort had a higher complication rate of 5.73% than the AO cohort at 2.48% (P < .001). After controlling for all other variables, there was no significant difference in morbidity (odds ratio [OR] = 1.05 [0.89 to 1.24]), mortality (OR = 0.91 [0.49 to 1.70]), readmission (OR = 1.29 [0.92 to 1.81]), or reoperation (OR = 1.28 [0.91 to 1.80]) for AR compared to AO cases. There was no difference between postgraduate year levels for adjusted 30-day morbidity or mortality.


CONCLUSIONS
There is an increased incidence of morbidity, mortality, readmission, and reoperation in OHNS surgical cases with resident participation, which appears related to increased comorbidity with AR patients. After controlling for other variables, resident participation was not associated with an increase in 30-day morbidity, mortality, readmission, or reoperation odds. These data suggest that OHNS resident participation in surgical cases is not associated with poorer short-term outcomes.


LEVEL OF EVIDENCE
3b Laryngoscope, 126:2263-2269, 2016.
['Abt|Nicholas B|NB|', 'Reh|Douglas D|DD|', 'Eisele|David W|DW|', 'Francis|Howard W|HW|', 'Gourin|Christine G|CG|']
D000328:Adult D000368:Aged D016022:Case-Control Studies D002983:Clinical Competence D016208:Databases, Factual D005260:Female D006801:Humans D015994:Incidence D007396:Internship and Residency D008297:Male D008875:Middle Aged D009017:Morbidity D016017:Odds Ratio D010036:Otolaryngology D013517:Otorhinolaryngologic Surgical Procedures D010359:Patient Readmission D011183:Postoperative Complications D012086:Reoperation
Resident morbidity mortality outcomes housestaff surgeon National Surgical Quality Improvement Program attending otolaryngology