Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy

•We evaluated effect of resident involvement in colectomy for malignancy.•Effect of resident involvement was evaluated in subset analysis of open and laparoscopic colectomy for malignancy.•Resident involvement was independently associated with increased 30-day overall morbidity.•Lower mortality and lower failure to rescue were seen in patients undergoing colectomy with assistance of a resident physician.

BackgroundWe evaluated effect of resident involvement on outcomes after laparoscopic and open colon resection for malignancy.MethodsPatients undergoing colectomy were queried using the American College of Surgeons' National Surgical Quality Improvement Program. “Attending alone” and “Resident” cohorts were compared with primary end point of overall morbidity.ResultsOf 37,330 patients, residents were involved in 26,190 (70.2%) cases. Attending alone patients were older with higher vascular, cardiac, and pulmonary comorbidity. Univariate analysis demonstrated increased operative time (181.0 ± 98.4 vs 138.7 ± 77.0, P < .001), reoperation (5.7% vs 5.2%, P = .041), and readmission rates (11.9% vs 9.6%, P = .037) with resident involvement. Serious (16.0% vs 13.9%, P < .001), minor (17.5% vs 14.1%, P < .001), and overall morbidity (26.4% vs 22.5%, P < .001) were higher with resident participation. Mortality (2.0% vs 2.8%, P < .001) and failure to rescue (.8% vs 1.2%, P < .029) were lower with resident involvement. Resident involvement showed independent association with overall morbidity in both laparoscopic (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.38, P < .001) and open cases (odds ratio 1.3, 95% confidence interval, 1.18 to 1.35, P < .001).ConclusionsResident participation in colectomy for malignancy is associated with lower mortality at the expense of higher overall morbidity.