Trends in Resident Supervision and Patient Outcomes of Laparoscopic Cholecystectomies Within the Veterans Affairs Healthcare System

OBJECTIVE: We sought to use the Veterans Affairs Surgi-cal Quality Improvement Program (VASQIP) database to determine if there is an increase in morbidity or mortal-ity when resident physicians independently perform lap-aroscopic cholecystectomy compared to when an attending surgeon is scrubbed.DESIGN: We performed a retrospective review of 54,144 cases of laparoscopic cholecystectomy per-formed within the Veterans Affairs (VA) Healthcare sys-tem from 2000 to 2020. Cases were divided into groups based on if the attending was scrubbed or not scrubbed. We then performed 1:1 case matching without replace-ment based on sex, race, and major comorbidities.PARTICIPANTS: Veterans over age 18 undergoing lapa-roscopic cholecystectomy within the VA healthcare sys-tem between 2000 and 2020. Cases were excluded if a resident was not involved in the surgery or if the level of autonomy was not defined.RESULTS: Significantly more operative cases were per-formed without the attending scrubbed before 2003 than after (14.6% vs 1.60%, p < 0.01). After matching, in 1464 (48.6%) cases the attending physician was scrubbed, and in 1549 (51.4%) the attending physician was not scrubbed. Patients were statistically similar in all measured comorbidities between the groups. Operative time was noted to be slightly longer when the attending was scrubbed (1.86 hours +/- 0.79 vs 1.72 +/- 0.67, p < 0.01) as well as increased complication rates (9.0% vs 6.1%, p < 0.01). No differences existed for 30-day mor-tality (0.8% vs 0.5%, p = 0.416), postoperative length of stay (2.7 days vs 2.96 days, p = 0.43), or superficial infec-tion (1.9% vs 1.7%, p = 0.73). CONCLUSIONS: Our analysis of the VASQIP database indicates that decreased resident supervision during lap-aroscopic cholecystectomy has minimal impact on patient outcomes. Rates of resident independent operat-ing have declined 10-fold since the early 20000s. Further research is required to better define the changes in resi-dent surgical education and their impact on patient out-comes. (J Surg Ed 80:442-447.(c) 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)