(248) Association Between Resident Participation in Cesarean Delivery and Complications and Operative Times

Objective:
To evaluate whether resident physician involvement in cesarean delivery was associated with increased maternal or neonatal morbidity and increased operative times.

Study Design:
Secondary analysis of the MFMU APEX study, a multicenter observational cohort of deliveries occurring from 2008-2011. Participants with a non-anomalous, singleton term cesarean were included. The exposure was resident involvement in cesarean. The primary outcome was serious maternal operative morbidity, defined as bowel or genitourinary injury; peripartum hysterectomy for uterine trauma; reoperation for bleeding or uterine trauma; wound dehiscence requiring reoperation; or maternal death. Secondary outcomes were minor maternal operative morbidity; composite neonatal morbidity; operative time from skin incision to delivery; and total operative time from incision to completion. Propensity scores were calculated using maternal demographics, comorbidities, and labor characteristics. Risk ratios reported from ATT weighted analysis.

Results:
Among 28,087 included deliveries, 73.8% (n=20,728) had resident involvement. In propensity weighted models, resident involvement was not associated with serious maternal operative morbidity (0.6% vs 0.4%, aRR 1.24, 95% CI 0.71-2.14). However, resident involvement was associated with higher risk of minor maternal operative morbidity, longer operative times, and lower risk of neonatal morbidity (Table 2). In exploratory analyses examining the number of residents involved, results were similar in magnitude and direction to primary analysis regardless of whether comparing 2 or 3 residents to none, or 1 resident to none (data not shown).

Conclusion:
Resident involvement in cesarean deliveries was not associated with severe maternal morbidity, such as organ injury, reoperation, or death. However, trainee involvement was associated with increased minor maternal morbidity, driven primarily by postpartum hemorrhage, and longer operative times. While resident involvement was associated with lower neonatal morbidity, differences were not clinically significant.