20. Resident Versus No Resident: A Single Institutional Study on Surgical Complications, Mortality, and Cost

Introduction: Previous studies have shown an increase in surgical morbidity, mortality, length of stay (LOS), and cost in teaching hospitals (TH). These studies are confounded by many factors including large cross-sectional populations, disparate referral and practice patterns, analysis of all procedures grouped together, and disparate hospitals. Controlling for these confounding variables, we studied the effect of surgical residents on complications, mortality, length of stay (LOS), cost, and hospital margin in an academic based surgery residency program during rotations with non-academic based teaching faculty at a TH. Materials and Methods: Patients (n=2,293) received their care at a single TH from a group of eight surgeons associated with a large multi-specialty clinic. Four surgeons [group1(Grp 1)] did not have resident coverage and the other four, Grp 2, had resident coverage. Continuous severity adjusted complications, mortality, LOS in days, cost, and hospital margin data was collected over a forty-two month period from 1/1/03-7/31/06. Data was entered into a relational database. Data was also compared to 22 peer hospitals. Differences were compared using the unpaired Student’s t-test for continuous variables and Chi-Square for nominal variables, and were considered significant (*) for P < 0.05. Results: Analyzing all procedures together, there was no difference in complications, 3.78% vs. 5.07% (P=NS) although a lower mortality, 1.00% vs. 2.87% (P=0.004), Grp 1 vs. Grp 2 respectively. The cost for all patients was 46% higher in Grp 2 vs. Grp 1, P<0.0001, (1.09 vs. 0.85 compared to peer hospitals). Data is shown for the five most common procedures individually: major small/large bowel (bowel), laparoscopic cholecystectomy (chole), hernia excluding inguinal/femoral (hernia), mastectomy, and appendectomy. Analyzing these 5 procedures together, there was no significant difference in complications, 2.48% vs. 3.70%, Grp 1 vs. Grp 2 respectively. Although there were no complications or mortalities listed for either group of patients with an appendectomy and no difference in LOS or margin, the cost was significantly greater $5,700+/−2123 vs. $4,964+/−2072, (P=0.007), Grp 2 (n=151) vs. Grp 1 (n=101) respectively. Data for the other common procedures is shown in the table. TABLEResident Versus No Resident: Effect on Complications, Mortality, and Costs Data/Group Complications Mortality LOS Cost Margin Bowel-Grp 1 (n = 104) 6.7% 2.8% 6.94 5.37 $10,815 11,177 $3,655 8,131 Bowel-Grp 2 (n = 160) 11.3% 4.4% 9.36 7.01* $17,561 13,235* ($88) 10,227* Chole-Grp 1 (n = 55) 0.0% 0.0% 2.62 1.63 $5,545 1,837 $2,282 3,395 Chole-Grp 2 (n = 98) 1.0% 0.0% 3.40 2.58* $7,567 3,669* $1,345 4,969 Hernia-Grp 1 (n = 98) 3.1% 0.0% 2.75 1.70 $5,928, 2,914 $1,069 3,819 Hernia-Grp 2 (n = 107) 1.9% 1.9% 3.84 3.30* $8,897 7,793* ($138) 6,260* Mastectomy-Grp 1 (n = 85) 1.2% 0.0% 1.25 0.55 $3,969 1,610 $528 2,114 Mastectomy-Grp 2 (n = 73) 0.0% 0.0% 1.56 0.80* $4,651 2,005* $868 1,957 Open table in a new tab