Resident Participation Impact on Operative Time and Outcomes in Veterans Undergoing Total Laryngectomy.

Abstract

Objectives: The US Department of Veterans Affairs (VA) has been an integral component of resident education in otolaryngology. However, the impact of resident surgical training on patient outcomes and productivity in the VA is unknown. This study sought to determine how resident participation impacted complications, operative time, and productivity in veterans undergoing total laryngectomy.

Methods: Patients who underwent total laryngectomy, with or without neck dissection, were identified in the VA Surgical Quality Improvement Program database between 2001 and 2021. Operative time, work relative value units (wRVU) generated per hour, and postoperative complications were compared for attending physicians with junior residents, attending physicians with senior residents, and attending physicians alone. Patient demographics and preoperative health variables were collected to determine their impact on postoperative outcomes, including complication rate, return to the operating room (OR), and death within 30 days.

Results: This study identified 1857 veterans who underwent a total laryngectomy at a VA facility. Most laryngectomies were performed by an attending physician with a senior resident (64%), followed by attending physician alone (24%), and an attending physician with a junior resident (12%). Resident participation was significantly associated with increased operative time (P = .001) and lower wRVU per hour (P = .002). Resident participation did not significantly affect postoperative complication rate (21.3%; n = 395) or patient return to the OR (14.6%; n = 272). On multivariate analysis, junior resident involvement (P = .001), and weight loss > 10% (P = .007) were significantly associated with longer operative times. There was a statistically significant drop in the rate of resident participation in laryngectomies from 80.6% between 2001 and 2011 to 68.3% between 2012 and 2021 (P < .001).

Conclusions: Resident participation in total laryngectomies increased operative time and reduced wRVU generated per hour but did not impact complication rates or patient return to the OR. The VA remains an integral part of otolaryngology residency training programs, but there has been a decline in resident participation in total laryngectomies.