Association of Surgical Practice Patterns and Clinical Outcomes With Surgeon Training in University- or Nonuniversity-Based Residency Program

Abstract

<div class="section"> <a class="named-anchor" id="ab-soi170116-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e286">Question</h5> <p id="d1553090e288">Do the practice patterns and clinical outcomes of general surgeons differ by type of residency training? </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e291">Findings</h5> <p id="d1553090e293">In this cohort study of 3638 general surgeons trained at nonuniversity- and university-based residency programs, significant differences were noted in types and proportion of procedures performed between the inpatient and outpatient setting, but no statistically significant difference was observed in clinical outcomes among surgeons with similar practice patterns operating within the same hospital. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e296">Meanings</h5> <p id="d1553090e298">Surgeons trained in nonuniversity- and university-based residency programs have distinct practice patterns. When compared within the same clinical setting, surgeons from both training backgrounds achieve similar clinical outcomes. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e303">Importance</h5> <p id="d1553090e305">Important metrics of residency program success include the clinical outcomes achieved by trainees after transitioning to practice. Previous studies have shown significant differences in reported training experiences of general surgery residents at nonuniversity-based residency (NUBR) and university-based residency (UBR) programs. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e308">Objective</h5> <p id="d1553090e310">To examine the differences in practice patterns and clinical outcomes between surgeons trained in NUBR and those trained in UBR programs. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e313">Design, Setting, and Participants</h5> <p id="d1553090e315">This observational cohort study linked the claims data of patients who underwent general surgery procedures in New York, Florida, and Pennsylvania between January 1, 2012, and December 31, 2013, to demographic and training information of surgeons in the American Medical Association Physician Masterfile. Patients who underwent a qualifying procedure were grouped by surgeon. Practice pattern analysis was performed on 3638 surgeons and 1 237 621 patients, representing 214 residency programs. Clinical outcomes analysis was performed on 2301 surgeons and 312 584 patients. Data analysis was conducted from February 1, 2017, to July 31, 2017. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e318">Exposures</h5> <p id="d1553090e320">NUBR or UBR training status.</p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e323">Main Outcomes and Measures</h5> <p id="d1553090e325">Inpatient mortality, complications, and prolonged length of stay.</p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e328">Results</h5> <p id="d1553090e330">No significant differences were observed between the NUBR-trained surgeons and UBR-trained surgeons in age (mean, 53.3 years vs 53.7 years), sex (female, 18.2% vs 16.9%), or years of clinical experience (mean, 16.5 years vs 16.5 years). Overall, NUBR-trained surgeons compared with UBR-trained surgeons performed more procedures (median interquartile range [IQR], 328 [93-661] vs 164 [49-444]; <i>P</i> &lt; .001) and performed a greater proportion of procedures in the outpatient setting (risk difference, 6.5; 95% CI, 6.4 to 6.7; <i>P</i> &lt; .001). Before matching, the mean proportion of patients with documented inpatient mortality was lower for NUBR-trained surgeons than for UBR-trained surgeons (risk difference, −1.01; 95% CI, −1.41 to −0.61; <i>P</i> &lt; .001). The mean proportion of patients with complications (risk difference, −3.17%; 95% CI, −4.21 to −2.13; <i>P</i> &lt; .001) and prolonged length of stay (risk difference, −1.89%; 95% CI, −2.79 to −0.98; <i>P</i> &lt; .001) was also lower for NUBR-trained surgeons. After matching, no significant differences in patient mortality, complications, and prolonged length of stay were found between NUBR- and UBR-trained surgeons. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170116-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d1553090e348">Conclusions and Relevance</h5> <p id="d1553090e350">Surgeons trained in NUBR and UBR programs have distinct practice patterns. After controlling for patient, procedure, and hospital factors, no differences were observed in the inpatient outcomes between the 2 groups. </p> </div><p class="first" id="d1553090e353">This cohort study analyzes the claims data of patients who underwent general surgery and the practice and training information of surgeons in the American Medical Association Physician Masterfile to determine the association of surgical residency training with patient outcomes. </p>