Can chief residents perform umbilical hernia repair safely and efficiently with supervised independence?

Purpose We aimed to compare outcomes and operative costs of open umbilical hernia repairs between a chief resident service and standard academic services. Methods We matched adults undergoing umbilical hernia repair from 07/2016 to 06/2019 on the chief service to two standard academic service patients based on operative indication, sex, and age to compare complications, operative time and costs. Results Chief service patients ( n = 30) and standard service patients ( n = 60) presented with similar mean body mass index (31.8 vs 31.6, P = 0.55) and fascial defect size (1.6 cm vs 1.8 cm, P = 0.85) prior to umbilical hernia repair. Complication rates were similar (10.0% vs. 10.0%, P = 1.0) and there were no significant differences in recurrence (6.7% vs. 1.7%, P = 0.23), infection (0.0% vs. 5.0%, P = 0.12), or hematoma (0.0% chief, 1.7% standard, P = 0.37) between chief and standard services, respectively. No patients required readmission or reoperation within 30 days. The chief service averaged slightly longer operative times (38 ± 22 vs. 26 ± 16 min, P < 0.01) and more total time in the operating room (88 ± 34 vs. 70 ± 21 min, P < 0.01) compared to standard services, respectively. More time in the operating room translated into higher time-based costs for the chief service ($763 ± 295 vs. $609 ± 180 standard, P < 0.01), but the mean cost for materials was similar ($203 ± 145 vs. $231 ± 177 standard, P = 0.52). Conclusions The chief resident service provides safe operative care for patients undergoing umbilical hernia repair with outcomes similar to those observed in standard academic services. Although their operative times are longer, chief residents spend no more on materials than faculty when operating according to their preferences.