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

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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    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