Association for Academic Surgery Chief Residents can Safely Operate on Older and Frail Patients

Introduction: Older age and frailty increase the risk of poor recovery after surgery. We hy-pothesized that general surgery operations performed by supervised chief residents, as opposed to attending physicians, would still be safe for these vulnerable patients.Materials and methods: We used the Veterans Affairs Surgical Quality Improvement Program database to identify 114,525 patients age 65+ y, including 18,030 patients age 80+ y and 47,555 categorized as frail, who had a general surgery procedure from 1999 to 2019 that was performed by an attending physician or by a supervised chief resident. Frailty was defined by a Risk Analysis Index score >= 30. We used inverse probability weighting on the pro-pensity score to compare morbidity and mortality between operations performed by at-tendings versus chief residents.Results: Patients 65 y and above had a 2.1% increase in postoperative complications when the surgery was performed by a chief resident instead of an attending surgeon (95%CI 1.2%-3.0%, P < 0.0001). A similarly increased risk of complications was seen for patients age >= 80 y old (+2.3%, 95%CI 0.7%-3.9%, P = 0.004) and for frail patients (+2.7%, 95%CI 1.4%-4.0%, P < 0.0001). There were no differences in mortality for patients age 65+ y (+0.2%, 95%CI-0.1%-0.5%, P = 0.2), 80+ y (+0.3%, 95%CI -0.6%-1.1%, P = 0.5), or frail patients (+0.2%, 95% CI-0.5%-0.8%, P = 0.6) when their operations were performed by chief residents.Conclusions: We found a small increase in morbidity and no difference in mortality when older or frail patients were operated on by chief residents rather than attending surgeons. Our findings suggest that it is reasonable and safe for training programs to allow appro-priately supervised chief residents to operate on older or frail patients.(c) 2022 Elsevier Inc. All rights reserved.