Physician autonomy is an important component to medical training, but carries risks to patient safety. This retrospective cohort study used VA Surgical Quality Improvement Program (VASQIP) data from July 2004 through September 2019 to examine resident operative autonomy impacts patient outcomes. Findings indicate that surgical procedures performed by residents alone were not associated with higher rates of mortality or morbidity compared to procedures performed with the assistance of attending surgeons or by attending surgeons alone.