The Effect of Resident Participation on Appendectomy Operative Times.

Objective: To assess the association between level of resident autonomy and operative times for appendectomies.

Design: A single center retrospective analysis of electronic medical record data of patients who underwent an appendectomy from 1/1/2017 to 12/31/2018. Medical record numbers s were matched with cases entered in the ACGME Resident Case Log system. Cases were stratified by resident role ("First Assistant," "Surgeon Junior," "Surgeon Chief," or "Teaching Assistant") and operative times were compared to cases without resident participation using student's t test.

Setting: Maine Medical Center, Department of Surgery, Portland, Maine.

Participants: Inclusion criteria: ≥5 years old, underwent appendectomy at a tertiary medical center during the study duration, and either had corresponding Case-log data or had no resident involvement. Patients who underwent appendectomy as part of a larger procedure were excluded.

Results: Six hundred eighty-eight patients met inclusion criteria, with residents participating in 574 (83.5%) cases. Overall mean operating time was 51 ± 21.5 minutes. Attending physicians without resident participation had the shortest OR times (43 ± 19.1 minutes). There was no difference in operating time between chief resident involvement and attending physicians without resident participation (45 ± 21; p = 0.43). Cases with residents involved as "First Assistant" (53 ± 18.6 minutes; p = 0.04) "Surgeon Junior" (52 ± 24.0 minutes; p < 0.001), or "Teaching Assistant" (57 ± 21.6 minutes; p < 0.001) were found to have longer operating times as compared to attending physicians operating without a resident.

Conclusions: Operative times for appendectomies are impacted by resident role. Chief residents' operative times approach that of attendings when operating as Surgeon Chief, however they are significantly longer when operating as Teaching Assistant. Involvement of junior residents in any role lengthen operating times. This suggests that surgical education influences operating room efficiency.