• Juliane Beier, Elena Ahrens, Michael Rufino, Jashvin Patel, Omid Azimaraghi, Vivek Kumar, Timothy T Houle, Maximilian S Schaefer, Matthias Eikermann, and Karuna Wongtangman.
• Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: jb85powo@studserv.uni-leipzig.de.
• J Clin Anesth. 2023 Nov 1; 90: 111238111238.

ObjectiveWe studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications.DesignRetrospective hospital registry study.SettingTwo university-affiliated hospitals networks (MA and NY, USA).Patients140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021.MeasurementsMultivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery.Main ResultsIn 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03-1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01-1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02-1.42; p = 0.026, p-for-interaction = 0.056).ConclusionPatients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.Copyright © 2023 Elsevier Inc. All rights reserved.

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