Mortality and US Surgical Residents, 2000-2021

BACKGROUND: Mortality during surgical residency is poorly characterized nationally, limiting evidence to guide resident-safety strategies. We characterized overall and cause-specific mortality among US surgical residents and the distribution of suicide deaths during training. STUDY DESIGN: National retrospective cross-sectional study of residents enrolled in ACGME-accredited surgical residency programs from July 1, 2000, through June 30, 2021. Decedent records were linked to the National Death Index. All-cause and cause-specific mortality rates were calculated per 100,000 person-years. Poisson regression estimated incidence rate ratios (IRR) with 95% confidence intervals comparing 2015-2021 with 2000-2014. Suicide deaths were described by sex, postgraduate year, and academic timing. RESULTS: Among 132,243 residents contributing 481,008 person-years, 82 deaths occurred (median age, 31 years; 70.7% male). Suicide was the most common cause of death (26; 31.7%; 5.4/100,000 person-years), followed by accidents (20; 24.4%; 4.2/100,000 person-years) and neoplastic disease (17; 20.7%; 3.5/100,000 person-years). All-cause mortality was 19.1/100,000 person-years in 2000-2014 and 13.6/100,000 person-years in 2015-2021 (IRR, 0.71; 95% CI, 0.43-1.14). In 2015-2021, suicide accounted for 45.8% of deaths (11; 6.2/100,000 person-years; IRR, 1.27; 95% CI, 0.57-2.74). Of 26 suicide deaths, 16 (61.5%) occurred among PGY 1-2 residents and 14 (53.8%) between July and December. Suicide was the leading cause of death among males (23 of 58; 39.7%); neoplastic disease was the leading cause among females (7 of 24; 29.2%). CONCLUSIONS: Suicide was the most common cause of death among US surgical residents and accounted for nearly half of deaths in 2015-2021. Continued surveillance and structurally supported, transition-focused approaches to resident safety and help-seeking are warranted.