Also, as PGY increased, so did operative time – in both resident and nonresident groups. "This suggests that the reason for the increasing complications with increasing PGY years may have been related to increasing complexity of surgery," said Dr. Kiran.
"One overarching issue seems to be how we might achieve high-quality patient care and delivery of the clinical outcomes in the context of training," said Dr. Clifford Ko, a discussant.
However, he also acknowledged that teaching residents takes time. Dr. Ko, a colorectal surgeon and the director of the Center for Surgical Outcomes and Quality at the University of California, Los Angeles, questioned whether the longer operating time associated with resident involvement should be reduced.
"Although we would not perhaps be able to minimize time differences, I think that we have already achieved some mark of control by the gradation of responsibility over time, as residents continue with their training," Dr. Kiran said.
Although the surgical and mild complication rates were slightly greater, it’s unclear whether these differences are clinically relevant.
"The reasons for [these differences] are likely multifactorial and may be related to prolonged operative time. Considering that more complex cases may be performed in teaching hospitals and require resident participation, ‘resident’ could be a surrogate of severity of disease and intensity of operation – factors that may not be clearly discernible in a retrospective study – and this may explain the differences seen.
"Also, quality measures currently underway to reduce surgical site infections across the board may further minimize any of these differences that may exist," Dr. Kiran concluded.
The authors reported that they had no relevant disclosures.