The impact of resident involvement in breast reconstruction surgery outcomes by modality: An analysis of 4,500 cases

Background: The goal of this study was to determine the impact of resident involvement on various methods of breast reconstruction via an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) retrospective analysis. Methods: We performed a retrospective analysis of the ACS NSQIP database to identify patients undergoing breast reconstruction by free flap, implant, latissimus dorsi (LD), and transverse rectus abdominis myocutaneous (TRAM) flap reconstruction modalities. Primary outcomes measured include major and wound complications. Results: A total of 4,500 cases were included in this analysis, of which residents participated in 1,743 (38.7%). Major complications occurred in 7.2% of all cases, and wound complications occurred in 3.3% of all cases. BMI was positively correlated with major complications in free flap, implant, and TRAM reconstruction groups. Wound complications were associated with BMI in free flap, implant, and TRAM reconstruction, with steroid use in implant and TRAM reconstruction, and with a history of bleeding disorder in LD reconstruction. Resident involvement did not reach significance in any reconstruction group as an independent factor for major or wound complications. Conclusions: Resident involvement is safe and effective across implant, free flap, LD, and TRAM based methods of breast reconstruction with similar major and wound complication rates. Participation of trainees in these surgical cases is imperative for future patient care.