Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in California

Background. Some patients have concerns regarding the impact of surgical trainees on the quality of care that they receive in teaching hospitals. No population-based data exist that describe outcomes of surgical procedures in teaching and nonteaching hospitals; however, institutional data surest that teaching hospitals provide high-quality care. We hypothesized that the presence of a genial surgery residency program (GSRP) is associated with superior outcomes for pancreatic resection, a complex surgical procedure. Methods. A retrospective, population-based, risk-adjusted analysis of 5696 patients who underwent major pancreatic resection compares the outcomes of patients treated at hospitals with a GSRP (GSRP+) and those hospitals without a GSRP (GSRP-). Results. GSRP+ hospitals had a lower operative mortality rate (8.3% vs 11.0%; P < .001), a lower percentage of patients discharged to another acute care hospital or skilled nursing facility (6.5% vs 13.0%; P < .001), and a longer length of stay compared with GSRP- hospitals (22.1 ± 0.4 days vs 19.6 ± 0.3 days; P < .001). The observed difference in hospital morality rates was not significant after an adjustment was made for patient mix and hospital volume (9.7% vs 10.0%). However, superior outcomes were found in the university teaching hospitals, as compared with the affiliated teaching and the nonteaching hospitals (5.3% [P < .001] vs 11.4% vs 11.0%; risk adjusted, 8.0% [P < .05] vs 10.9% vs 10.0%). Conclusions. The presence of surgical trainees does not have an advise impact on the quality of care for One complex procedure, pancreatectomy, and is associated with superior operative mortality rate in university teaching hospitals.