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Association between surgical resident involvement and blood use in noncardiac surgery

Authors

  • Laurent G. Glance,

    Corresponding author
    1. Departments of Anesthesiology, Pathology and Laboratory Medicine, and Surgery, University of Rochester School of Medicine, Rochester, New York
    2. Center for Health Policy Research, Department of Medicine, University of California at Irvine, Irvine, California
    3. University HealthSystem Consortium, Chicago, Illinois
    4. RAND, RAND Health, Santa Monica, California
    • Address reprint requests to: Laurent G. Glance, MD, Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY 14642; e-mail: laurent_glance@urmc.rochester.edu.

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  • Dana B. Mukamel,

    1. Departments of Anesthesiology, Pathology and Laboratory Medicine, and Surgery, University of Rochester School of Medicine, Rochester, New York
    2. Center for Health Policy Research, Department of Medicine, University of California at Irvine, Irvine, California
    3. University HealthSystem Consortium, Chicago, Illinois
    4. RAND, RAND Health, Santa Monica, California
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  • Neil Blumberg,

    1. Departments of Anesthesiology, Pathology and Laboratory Medicine, and Surgery, University of Rochester School of Medicine, Rochester, New York
    2. Center for Health Policy Research, Department of Medicine, University of California at Irvine, Irvine, California
    3. University HealthSystem Consortium, Chicago, Illinois
    4. RAND, RAND Health, Santa Monica, California
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  • Fergal J. Fleming,

    1. Departments of Anesthesiology, Pathology and Laboratory Medicine, and Surgery, University of Rochester School of Medicine, Rochester, New York
    2. Center for Health Policy Research, Department of Medicine, University of California at Irvine, Irvine, California
    3. University HealthSystem Consortium, Chicago, Illinois
    4. RAND, RAND Health, Santa Monica, California
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  • Samuel F. Hohmann,

    1. Departments of Anesthesiology, Pathology and Laboratory Medicine, and Surgery, University of Rochester School of Medicine, Rochester, New York
    2. Center for Health Policy Research, Department of Medicine, University of California at Irvine, Irvine, California
    3. University HealthSystem Consortium, Chicago, Illinois
    4. RAND, RAND Health, Santa Monica, California
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  • Andrew W. Dick

    1. Departments of Anesthesiology, Pathology and Laboratory Medicine, and Surgery, University of Rochester School of Medicine, Rochester, New York
    2. Center for Health Policy Research, Department of Medicine, University of California at Irvine, Irvine, California
    3. University HealthSystem Consortium, Chicago, Illinois
    4. RAND, RAND Health, Santa Monica, California
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  • This project was supported by a grant from the Agency for Healthcare Research and Quality (RO1 HS 16737). The views presented in this manuscript are those of the authors and may not reflect those of the Agency for Healthcare Research and Quality. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Abstract

Background

Although there is significant variability in the rate of blood transfusion in surgical patients, the role of surgical skill as a determinant of blood use is unknown.

Study Design and Methods

We examined the association between surgery resident participation and intraoperative blood transfusion, and 30-day mortality and complications, among 381,036 patients undergoing noncardiac surgery, adjusting for patient factors and procedure complexity.

Results

Compared to attending surgeons working without a resident, cases in which the attendings worked with either Postgraduate Year (PGY) 3 to 4 resident or a PGY5 to 8 resident had a 56% (adjusted odds ratio [AOR], 1.56; 95% confidence interval [CI, 1.48-1.64) or a 78% (AOR, 1.78; 95% CI, 1.70-1.87) higher odds of receiving a blood transfusion, respectively. Involvement of surgical interns or junior residents (PGY1-2), whose role in the operative procedure is assumed to be limited, was associated with a 27% higher odds of receiving a blood transfusion (AOR, 1.27; 95% CI, 1.18-1.37). Overall, resident involvement was not associated with increased risk of 30-day mortality (AOR, 0.97; 95% CI, 0.91-1.04), but was associated with a slightly increased risk of complications (AOR, 1.13; 95% CI, 1.10-1.16).

Conclusion

Senior surgery resident participation in noncardiac surgery is associated with between a 56% to 78% higher risk of receiving a blood transfusion intraoperatively compared to attending surgeons working without a resident. Assuming that senior surgical trainees are performing critical parts of the operative procedure and are less skilled than attending surgeons, the findings from this exploratory study suggest that intraoperative blood transfusion may serve as an indirect measure of surgical technical quality.

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