Who is operating on you during a cesarean birth? At teaching hospitals, the answer often includes a resident physician. A new study suggests that involvement may affect what mothers experience during surgery.
Researchers at University of Utah Health analyzed 28,087 cesarean deliveries at 25 hospitals. Residents participated in nearly three-quarters of them.
Resident involvement was not associated with an increase in major complications, such as organ injury, a second surgery, or maternal death.
But less serious complications occurred in 5.4% of deliveries involving residents, compared with 2.2% without them. Most of that difference came from postpartum hemorrhage requiring a blood transfusion: 5.0% with resident involvement versus 1.8% without it.
The researchers adjusted for the fact that residents were more likely to participate in difficult cases, including unplanned cesareans and deliveries involving infection, diabetes, or high blood pressure. The difference remained.
There was also a notable pattern. Compared with cesareans without residents, the adjusted risk of minor maternal complications was 42% higher with one resident and 144% higher with two or three.
Surgery took longer, too: an average of 36.9 minutes without a resident, 45 minutes with one, and 52.1 minutes with two or three.
The study does not prove that residents caused the additional bleeding. Researchers could not determine how much of each surgery residents actually performed, and the data came from 2008–2011. Newborn outcomes were slightly better with resident involvement, although the authors said the difference was unlikely to be clinically significant.
None of this means hospitals should stop training residents. Teaching hospitals have to train the next generation of physicians.
But training takes place on real patients.
If resident involvement adds time and is associated with more hemorrhage requiring transfusion, hospitals need systems to manage that risk. How closely is the resident supervised? How carefully is blood loss monitored? How quickly does the attending step in?
Training doctors is necessary. Protecting patients while we train them is too.
