Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases

Surgical resident operative autonomy has decreased markedly over time, reducing resident readiness for independent practice. We sought to examine operative resident autonomy for emergency acute care surgery (ACS) compared to elective cases and associated patient outcomes at veterans affairs hospital...

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Bibliographic Details
Published in:The Journal of surgical research 2023-01, Vol.281, p.328-334
Main Authors: Sehat, Alvand J., Oliver, Joseph B., Yu, Yasong, Kunac, Anastasia, Anjaria, Devashish J.
Format: Article
Language:English
Subjects:
Acute care surgery
Appendectomy
Autonomy
Clinical Competence
Critical Care
Emergency
General surgery
General Surgery - education
Humans
Internship and Residency
Operative Time
Quality Improvement
Surgeons
United States - epidemiology
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Summary:Surgical resident operative autonomy has decreased markedly over time, reducing resident readiness for independent practice. We sought to examine operative resident autonomy for emergency acute care surgery (ACS) compared to elective cases and associated patient outcomes at veterans affairs hospitals. The Veterans Affairs Surgical Quality Improvement Program database was queried for ACS cases (emergency general, vascular, and thoracic) at veterans affairs hospitals from 2004 to 2019. Cases are coded prospectively for the level of supervision: attending primary surgeon (AP); attending scrubbed with resident surgeon (AR); resident primary (RP), attending not scrubbed. Baseline demographics, operative variables, and outcomes were compared. A total of 61,275 ACS cases and 605,146 elective cases were performed during the study period. The ACS had a higher proportion of RP cases (7.2% versus 5.7%, P 
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2022.08.041