• Colby J Seegmiller, Andrew J Borgert, Kara J Kallies, and Benjamin T Jarman.
• General Surgery Residency, Department of Medical Education, Gundersen Health System, La Crosse, Wisconsin.
• J Surg Educ. 2020 Nov 1; 77 (6): e164-e171.

ObjectiveA chief resident service (CRS) provides a unique environment to assess competence throughout all aspects of patient care. The American College of Surgeons National Surgical Quality Improvement Program and Quality in Training Initiative databases are utilized to assess patient outcomes by individual residents with institutional and national comparisons. We hypothesized that residents on the CRS would have equivalent patient care outcomes to peers not on CRS and to chief residents nationally.DesignAn institutional National Surgical Quality Improvement Program database was queried from 2014 to 2019 for operations performed on the CRS. Thirty-day complications were compared between CRS and non-CRS postgraduate year (PGY)-5 residents. Quality in Training Initiative reports were used to compare residents on CRS to national PGY-5 residents. Statistical analysis included chi-square tests, and multivariate logistic regression.SettingIndependent academic medical center.ParticipantsChief general surgery residents.ResultsA total of 1031 cases were included in the analysis; 562 while off CRS and 469 while on CRS. Thirty-day outcomes were similar for CRS vs non-CRS cases for any complication (8% vs 12%, p = 0.05), unplanned readmissions (6% vs 5%, p = 0.58), and mortality (2% vs 2%, p = 0.99). Adjusting for patient and operative risk factors and procedure type, the rate of any complication after an operation on CRS vs off CRS was similar (odds ratio = 1.46, 95%confidence interval 0.82-2.60; p = 0.20). CRS residents had higher rates of postoperative renal failure (1.3% vs 0.5%, p = 0.008), but lower rates of organ space surgical site infection (0.6% vs 2.9%, p < 0.001), myocardial infarction (0 vs 0.6%, p = 0.04), pneumonia (0.3% vs 1.6%, p = 0.006), septic shock (0.1% vs 1.0%, p = 0.02), transfusion (2.7% vs 8.3%, p < 0.001), and fewer unplanned readmissions (6.1% vs 8.4%, p = 0.029) when compared to PGY-5 residents nationally.ConclusionsPatient care outcomes provided by PGY-5 residents on a CRS are comparable to those on non-CRS rotations and to PGY-5 residents nationally.Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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