# Impact of Residents’ Mass Resignation in Cardiovascular Surgery: A System Sustainability Perspective

## TL;DR

A mass resignation of medical residents in South Korea led to significant disruptions in cardiovascular surgery, including longer waiting times and worse patient outcomes.

## Contribution

This study reveals the systemic vulnerabilities in healthcare when resident labor is over-relied upon, using cardiovascular surgery as a case study.

## Key findings

- Surgical volume dropped by 58% during resident absence and did not recover to pre-resignation levels.
- Resident absence was an independent risk factor for failure-to-rescue complications and failure-to-rescue outcomes.
- Median surgical waiting times increased significantly during the period of resident absence.

## Abstract

In February 2024, a nationwide resident resignation occurred in South Korea that persisted for more than one and a half years and caused unprecedented disruptions in teaching hospitals. This study evaluated the clinical and socioeconomic impact of resident absence on cardiovascular surgery at a tertiary teaching hospital.

We retrospectively reviewed 681 patients who underwent open-heart or aortic surgery between February 20 and November 30, 2023 (before resident absence) and in 2024 (resident absence). Each year was divided into 3 periods (Q1, Q2, and Q3) for temporal comparison. The primary outcomes were 30-day mortality, failure-to-rescue complications, and failure-to-rescue. Failure-to-rescue was defined as in-hospital mortality after one or more of the following failure-to-rescue complications: acute renal failure, respiratory complications (prolonged ventilation >24 h, pneumonia, or tracheostomy), stroke, reoperation, life-threatening arrhythmia, postoperative myocardial infarction, or culture-positive sepsis. Multivariable logistic regression was performed to identify independent risk factors.

When comparing 2023 Q1 with 2024 Q1, surgical volume decreased from 154 to 65 cases (−58%) and did not return to 2023 Q1 baseline. Compared with the 2023 group, the median surgical waiting time of the 2024 group increased from 17 [IQR: 8-28] to 36 [IQR: 20-58] days (P < .001). Resident absence was not a risk factor for 30-day mortality but was an independent risk factor for both failure-to-rescue complications (OR 1.50, 95% CI 1.03-2.19, P = .035) and failure-to-rescue (OR 3.64, 95% CI 1.33-9.98, P = .012).

The nationwide resignation of residents revealed the structural vulnerability of South Korea’s healthcare system, which relies heavily on residents’ workforce. Surgical capacity decreased, waiting times increased, and rescue outcomes deteriorated. The resident-dependent healthcare system requires reform, with teaching hospitals treating residents primarily as trainees rather than as inexpensive labour.

Residents hold a unique position, serving as both salaried employees and trainees.