Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?

Navin R. Changoor, Gezzer Ortega, Mina Ekladios, Cheryl K. Zogg, Edward E. Cornwell, Adil H. Haider

Research output: Contribution to journalArticle

Abstract

Background Despite recognition of racial/ethnic surgical disparities, few studies have considered the role of surgical residents. This study aimed to elucidate whether disparities in postoperative outcomes are associated with the presence/level of surgical residents involved in procedures. Methods Patients who were classified as having laparoscopic cholecystectomy, laparoscopic appendectomy, and open hernia repair in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database were compared by level of provider (junior residents postgraduate year 1-2, senior residents, attending alone) for differences in patient demographics, clinical case-mix, and postoperative outcome information by the use of descriptive statistics and multivariable logistic regression. Results A total of 196,770 patients met inclusion criteria. Attendings performed 43.0% of operations alone (senior residents 37.5%, junior residents 20.1%), They operated on 44.1% white, 30.1% black, and 43.9% Hispanic patients compared with 35.5%, 48.7%, and 41.3% and 20.4%, 21.3%, and 14.8% for senior and junior residents, respectively. Compared with attendings alone, senior residents were more likely to operate on black patients (adjusted odds ratio [OR] 2.02, 95% confidence interval [95% CI] 1.95-2.09) and have major (OR 1.13, 95% CI 1.06-1.21) and minor complications (OR 1.20, 95% CI 1.11-1.31). Junior residents also were more likely to operate on black patients but did not experience significantly worse outcomes. Conclusion Greater risk-adjusted odds of complications among patients treated by senior residents need to be carefully weighed given the group's higher likelihood of operating on minority patients.

Original languageEnglish (US)
Pages (from-to)547-555
Number of pages9
JournalSurgery
Volume158
Issue number2
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Odds Ratio
Confidence Intervals
Appendectomy
Surgeons
Diagnosis-Related Groups
Herniorrhaphy
Laparoscopic Cholecystectomy
Quality Improvement
Hispanic Americans
Logistic Models
Demography
Databases
hydroquinone

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Changoor, N. R., Ortega, G., Ekladios, M., Zogg, C. K., Cornwell, E. E., & Haider, A. H. (2015). Racial disparities in surgical outcomes: Does the level of resident surgeon play a role? Surgery, 158(2), 547-555. https://doi.org/10.1016/j.surg.2015.03.046

Racial disparities in surgical outcomes : Does the level of resident surgeon play a role? / Changoor, Navin R.; Ortega, Gezzer; Ekladios, Mina; Zogg, Cheryl K.; Cornwell, Edward E.; Haider, Adil H.

In: Surgery, Vol. 158, No. 2, 01.08.2015, p. 547-555.

Research output: Contribution to journalArticle

Changoor, NR, Ortega, G, Ekladios, M, Zogg, CK, Cornwell, EE & Haider, AH 2015, 'Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?', Surgery, vol. 158, no. 2, pp. 547-555. https://doi.org/10.1016/j.surg.2015.03.046
Changoor NR, Ortega G, Ekladios M, Zogg CK, Cornwell EE, Haider AH. Racial disparities in surgical outcomes: Does the level of resident surgeon play a role? Surgery. 2015 Aug 1;158(2):547-555. https://doi.org/10.1016/j.surg.2015.03.046
Changoor, Navin R. ; Ortega, Gezzer ; Ekladios, Mina ; Zogg, Cheryl K. ; Cornwell, Edward E. ; Haider, Adil H. / Racial disparities in surgical outcomes : Does the level of resident surgeon play a role?. In: Surgery. 2015 ; Vol. 158, No. 2. pp. 547-555.
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abstract = "Background Despite recognition of racial/ethnic surgical disparities, few studies have considered the role of surgical residents. This study aimed to elucidate whether disparities in postoperative outcomes are associated with the presence/level of surgical residents involved in procedures. Methods Patients who were classified as having laparoscopic cholecystectomy, laparoscopic appendectomy, and open hernia repair in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database were compared by level of provider (junior residents postgraduate year 1-2, senior residents, attending alone) for differences in patient demographics, clinical case-mix, and postoperative outcome information by the use of descriptive statistics and multivariable logistic regression. Results A total of 196,770 patients met inclusion criteria. Attendings performed 43.0{\%} of operations alone (senior residents 37.5{\%}, junior residents 20.1{\%}), They operated on 44.1{\%} white, 30.1{\%} black, and 43.9{\%} Hispanic patients compared with 35.5{\%}, 48.7{\%}, and 41.3{\%} and 20.4{\%}, 21.3{\%}, and 14.8{\%} for senior and junior residents, respectively. Compared with attendings alone, senior residents were more likely to operate on black patients (adjusted odds ratio [OR] 2.02, 95{\%} confidence interval [95{\%} CI] 1.95-2.09) and have major (OR 1.13, 95{\%} CI 1.06-1.21) and minor complications (OR 1.20, 95{\%} CI 1.11-1.31). Junior residents also were more likely to operate on black patients but did not experience significantly worse outcomes. Conclusion Greater risk-adjusted odds of complications among patients treated by senior residents need to be carefully weighed given the group's higher likelihood of operating on minority patients.",
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AU - Cornwell, Edward E.

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N2 - Background Despite recognition of racial/ethnic surgical disparities, few studies have considered the role of surgical residents. This study aimed to elucidate whether disparities in postoperative outcomes are associated with the presence/level of surgical residents involved in procedures. Methods Patients who were classified as having laparoscopic cholecystectomy, laparoscopic appendectomy, and open hernia repair in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database were compared by level of provider (junior residents postgraduate year 1-2, senior residents, attending alone) for differences in patient demographics, clinical case-mix, and postoperative outcome information by the use of descriptive statistics and multivariable logistic regression. Results A total of 196,770 patients met inclusion criteria. Attendings performed 43.0% of operations alone (senior residents 37.5%, junior residents 20.1%), They operated on 44.1% white, 30.1% black, and 43.9% Hispanic patients compared with 35.5%, 48.7%, and 41.3% and 20.4%, 21.3%, and 14.8% for senior and junior residents, respectively. Compared with attendings alone, senior residents were more likely to operate on black patients (adjusted odds ratio [OR] 2.02, 95% confidence interval [95% CI] 1.95-2.09) and have major (OR 1.13, 95% CI 1.06-1.21) and minor complications (OR 1.20, 95% CI 1.11-1.31). Junior residents also were more likely to operate on black patients but did not experience significantly worse outcomes. Conclusion Greater risk-adjusted odds of complications among patients treated by senior residents need to be carefully weighed given the group's higher likelihood of operating on minority patients.

AB - Background Despite recognition of racial/ethnic surgical disparities, few studies have considered the role of surgical residents. This study aimed to elucidate whether disparities in postoperative outcomes are associated with the presence/level of surgical residents involved in procedures. Methods Patients who were classified as having laparoscopic cholecystectomy, laparoscopic appendectomy, and open hernia repair in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database were compared by level of provider (junior residents postgraduate year 1-2, senior residents, attending alone) for differences in patient demographics, clinical case-mix, and postoperative outcome information by the use of descriptive statistics and multivariable logistic regression. Results A total of 196,770 patients met inclusion criteria. Attendings performed 43.0% of operations alone (senior residents 37.5%, junior residents 20.1%), They operated on 44.1% white, 30.1% black, and 43.9% Hispanic patients compared with 35.5%, 48.7%, and 41.3% and 20.4%, 21.3%, and 14.8% for senior and junior residents, respectively. Compared with attendings alone, senior residents were more likely to operate on black patients (adjusted odds ratio [OR] 2.02, 95% confidence interval [95% CI] 1.95-2.09) and have major (OR 1.13, 95% CI 1.06-1.21) and minor complications (OR 1.20, 95% CI 1.11-1.31). Junior residents also were more likely to operate on black patients but did not experience significantly worse outcomes. Conclusion Greater risk-adjusted odds of complications among patients treated by senior residents need to be carefully weighed given the group's higher likelihood of operating on minority patients.

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