RESIDENT SUPERVISION IN THE OPERATING-ROOM - DOES THIS IMPACT ON OUTCOME

Resident supervision by faculty is a sine qua non of surgical educatio n, yet objective standards for supervision are difficult to quantify. Over a 12-month period, using departmental data on morbidity, mortalit y outcome, and faculty status in the operating room, the association b etween complications, death, and attending physician presence were ana lyzed by Chi-square tests of association in 2 x 2 contingency tables, or by the Mantel-Haenszel Chi-square to control for a stratifying vari able. A total of 4417 cases were reported. Attending physicians were e ither scrubbed or present in the OR 91.8% of the time, although there was considerable variation among services. The overall mortality rate was 6.2% and complications occurred in 7.0% overall. Greater attending physician presence was significantly associated with lower mortality and complication rates overall. When stratified by service, the associ ation was less marked. However, presence of attending physicians varie d significantly by service. To adjust for this variation, elective ser vices were compared with all the ''nonelective'' services. When this c ategorization was used as the stratifying variable, the association be tween increased attending physician involvement and decreased complica tion and mortality rates was statistically significant (Mantel-Haensze l Chi-square, p < 0.0005 for both).