Comparing Resident Team Performance in Complex Surgical Oncology: A Single-Institution Cohort Study

BACKGROUND: Team dynamics influence team performance and patient outcomes in surgery, yet data on resident-led teams are scarce. This study aimed to compare patient outcomes across resident-led teams in complex surgical oncology. We hypothesized that patient outcomes would vary by team assignment. METHODS: This was a retrospective cohort study of resident-led teams who contributed more than 10 surgical oncology operations (colectomy, hepatectomy, pancreatectomy, or thyroidectomy) to the National Surgical Quality Improvement Project registry at a single university-based hospital (2018-2025). The primary outcome was presence of any adverse event, including mortality and postoperative complications. Length of stay and 30-day readmissions were also examined. Mixed-effects regression estimated expected outcome probabilities for each patient. For each team, observed-minus-expected (O-E) outcome rates were calculated to assess performance. RESULTS: In total, 145 teams cared for a median of 22 patients (interquartile interval 16- 27; n = 2919). Five teams demonstrated poor performance based on risk-adjusted adverse event rates (O-E rates: 6.9% and 22.3%). A total of 13 teams had significantly longer risk-adjusted length of stays than expected (O-E between 0.4 and 3.5 days), and seven teams had shorter risk-adjusted length of stays than expected (O-E between -1.1 and -0.7 days). Three teams had higher risk-adjusted readmission rates than expected (O-E between 4.9% and 6.8%). Two teams performed poorly across all three outcomes. CONCLUSIONS: Variation in team performance can be measured using valid and reliable risk-adjusted patient outcomes in complex surgical oncology. This may provide meaningful feedback with benchmarking to identify teams that require more supervision.