Is Procedural Anesthesia Safety Similar Between Residents and Attending Surgeons?

BACKGROUND

The safety of the single-provider anesthesia model in oral and maxillofacial surgery (OMS) is well established. While previous studies have shown operative outcomes similar between attending surgeons and resident trainees, it remains unclear if the same is true for procedural (deep sedation to general) anesthesia.

PURPOSE: The study purpose was to estimate and compare the frequencies of anesthesia-related adverse events between residents and attendings.

STUDY DESIGN, SETTING, SAMPLE: This was a retrospective cohort study. Subjects who received procedural sedation between 2012 and 2020 at the University of Alabama at Birmingham outpatient clinics were identified through review of electronic medical records and paper charts. Exclusion criteria included incomplete documentation of demographics, periprocedural events, or sedation medications, and procedures not performed by providers within the University of Alabama at Birmingham Department of OMS. The sedation model adheres to the American Association of Oral and Maxillofacial Surgeons team-based approach, emphasizing structured roles and monitoring.

PREDICTOR VARIABLE: The predictor variable was the type of surgeon performing the procedural sedation: attending versus resident.

OUTCOME VARIABLE: The outcome variables were adverse events (respiratory, cardiac, neurological, allergy, aspiration, and medication errors).

COVARIATES: Subject demographics (age, sex), smoking status, American Society of Anesthesiologists physical status, medications (identity, dose, and route), and procedure duration.

ANALYSES: Descriptive statistics were reported as counts and frequencies for categorical variables and means, standard deviations, ranges, and interquartile ranges for continuous variables. χ2 and Fisher exact test was used for bivariate analysis. P value <.05 was considered statistically significant. All analyses were conducted using SAS 9.4.

RESULTS

The sample was composed of 3,940 subjects with a mean age of 37.05 ± 21.41 years, and n = 1,595 (41.52%) were male (P =< .001). There were n = 985 (25.1%) and n = 2,951 (74.9%) subjects in the resident and attending samples, respectively. One adverse event (0.1%) occurred in the resident clinic (apnea), while 2 events (0.07%) occurred in the attending clinic (bradycardia; postoperative nausea and vomiting), with no statistically significant difference between groups (P = 1.0).

CONCLUSIONS AND RELEVANCE: Procedural sedation administered by both OMS residents and attendings in an academic outpatient setting demonstrated a similarly low rate of adverse events (0.08%), with no permanent sequelae. These findings support the safety of supervised resident-delivered sedation and validate current OMS training protocols.