The impact of surgical resident participation in breast reduction surgery – Outcome analysis from the 2005–2011 ACS-NSQIP datasets

Abstract

Breast reduction surgery is a common and effective surgical technique for treating symptomatic macromastia. There is limited data on the impact of resident involvement on outcomes. This study uses the ACS-NSQIP datasets to assess the impact of surgical resident participation in breast reduction surgery. This study reviewed the 2005-2011 ACS-NSQIP databases identifying primary encounters for reduction mammaplasty with CPT code "19318". It characterised surgical complications into three groups: any, major, and wound complications. Propensity scoring and matched analysis were used to account for non-randomised assignment. In total, 4328 patients underwent reduction mammoplasty during the study period. Resident participation was identified in 56.3% of cases. Logistic regression analysis determined the following factors independently associated with resident participation: class II obesity (OR = 0.73, p < 0.001), class III obesity (OR = 0.68, p < 0.001), dyspnea (OR = 1.59, p = 0.04), and ASA physical status of 3 (OR = 1.51, p < 0.001). A propensity score was assigned based on probability of resident involvement and matched cohorts were created and analyzed. A logistic regression analysis of the matched cohort data revealed that resident participation was independently associated with major surgical complications (OR = 2.18, p = 0.008). Prolonged operative (>2 SD) was associated with any (OR = 3.3, p = 0.039) and wound (OR = 10.2, p = 0.028) complications. A separate logistic regression analysis of the unmatched cohort using stratified PGY experience demonstrated that junior PGY was most highly associated with any (OR = 1.93, p = 0.013), major (OR = 2.4, p = 0.034), and wound (OR = 1.9, p = 0.04) complications. Resident participation was associated with added risk of surgical morbidity, and PGY experience was inversely related to risk of surgical complications in breast reduction surgery.

The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections

“…Single-institution studies as well as large, multi-institution studies have analyzed the impact of resident participation after a variety of operations in general, 2,3 vascular, 4,5 oncologic, 6 and breast 7 subspecialties. However, to our knowledge, the impact of resident participation on perioperative outcomes after only complex liver and pancreatic resections has not been studied.…”

“…Several previous studies have examined the impact of resident participation and outcomes using this database. Specifically, outcomes after operations in general, 2,3 vascular, 4,5 oncologic, 6 and breast 7 surgeries have been studied and reported. These reports on the impact of resident participation on perioperative outcome have been mixed; some studies show no effect, whereas others have shown a correlation between resident participation and poorer perioperative outcomes.…”

Does resident involvement in thyroid surgery lead to increased postoperative complications?

“…Due to this worry, the medical community has recently started investigating the topic. Studies in general, plastic, orthopedic, urologic, and head and neck surgery have yielded inconsistent results regarding the potentially adverse influence resident participation in surgery has on postoperative outcomes.…”

The Impact of Resident Participation in Outpatient Plastic Surgical Procedures

“…Within plastic surgery, the impact of resident participation has also been described in non-aesthetic reconstructive surgery as well as reduction mammoplasty. In non-aesthetic reconstructive surgery, residents were reported to have similar complication rates as attendings alone, though resident participation was associated with increased surgical morbidity in reduction mammoplasty [14,15]. The authors sought to characterize the impact of resident participation in outpatient plastic surgical procedures.…”

“…The impact of resident participation in plastic surgery has been studied in non-aesthetic plastic surgery, which showed that resident presence had similar complication profiles to attending surgeons alone [14]. However, in breast reduction, resident participation was reported to be associated with increased surgical morbidity [15]. Additionally, unpublished negative opinions regarding resident participation have been anecdotal and based on limited, unreliable information [16].…”