Ethical Dilemmas in Orthopaedic Surgical Training

Holt, Geraldine; Nunn, Tom; Gregori, A.

doi:10.2106/jbjs.h.00910

Cited by 20 publications

(12 citation statements)

References 45 publications

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“…Attending-level surgeons are often tasked with balancing the delivery of safe and effective patient care with the expectation of hands-on resident education. 2,7,16 This fine balance of care versus education is complicated by additional external pressures from the health care system as well as from the patient and patient’s family. 7 There is increasing pressure from hospital administration and the health care system to increase productivity while limiting cost; at the same time, patients and their families are increasingly aware of trainee involvement.…”

Section: Discussionmentioning

confidence: 99%

Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

Basques

Saltzman

Mayer

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Shoulder arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement.Purpose:To compare shoulder arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks.Study Design:Cohort study; Level of evidence, 3.Methods:The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 shoulder arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts.Results:A total of 15,774 patients with shoulder arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time (P = .219).Conclusion:Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in shoulder arthroscopy cases is a safe method for trainees to learn these procedures.

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Section: Discussionmentioning

confidence: 99%

Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

Basques

Saltzman

Mayer

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…14 The full methodology of the data-collection process used by the ACS-NSQIP is described elsewhere. 15 Briefly, patients are identified prospectively and randomly sampled at eligible hospitals. Clinical data are collected for the entire 30-day postoperative period, regardless of discharge status within this time.…”

Section: Methodsmentioning

confidence: 99%

“…However, a consequence of this system is concern regarding patient safety, coupled with the external pressures of operating room time and cost efficiency. 3,15 Previous studies have investigated the impact of resident involvement on adverse outcomes and readmissions after spine surgery, total joint arthroplasty, and shoulder arthroscopy. 2,5,7,9,13,14 The purpose of the current study was to use a large national data set to compare operative time, adverse events, and readmission for arthroscopic knee surgery cases with and without resident involvement.…”

mentioning

confidence: 99%

Resident Involvement in Arthroscopic Knee Surgery Is Not Associated With Increased Short-term Risk to Patients

Basques

Saltzman

Korber

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Whether resident involvement in surgical procedures affects intra- and/or postoperative outcomes is controversial. Purpose/Hypothesis: The purpose of this study was to compare operative time, adverse events, and readmission rate for arthroscopic knee surgery cases with and without resident involvement. We hypothesized that resident involvement would not negatively affect these variables. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of the prospectively maintained National Surgical Quality Improvement Program was performed. Patients who underwent arthroscopic knee surgery between 2005 and 2012 were identified. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Because of multiple statistical comparisons, a Bonferroni correction was used, and statistical significance was set at P < .004. Results: A total of 29,539 patients who underwent arthroscopic knee surgery were included in the study, and 11.3% of these patients had a resident involved with the case. The overall rate of adverse events was 1.62%. On multivariate analysis, resident involvement was not associated with increased rates of adverse events or readmission. Resident cases had a mean 6-minute increase in operative time ( P < .001). Conclusion: Overall, resident involvement in arthroscopic knee surgery was not associated with an increased risk of adverse events or readmission. Resident involvement was associated with only a mean increased operative time of 6 minutes, a difference that is not likely to be clinically significant. These results support the safety of resident involvement with arthroscopic knee surgery.

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“…Recently, resident participation has come under increased scrutiny as an area for improved efficiency and safety in patient care. 1,2 As more emphasis is placed on outcomes and j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 7 ( 2 0 1 6 ) 2 2 9 -2 3 3 a r t i c l e i n f o Results: Resident involvement had no effect in the incidence of wound and minor complications among all three anatomic sites of orthopedic trauma procedures (hip, lower extremity…”

Section: Introductionmentioning

confidence: 99%

The impact of resident involvement on outcomes in orthopedic trauma: An analysis of 20,090 cases

Mitchell¹,

Гаврилова²,

Dodd³

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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Ethical Dilemmas in Orthopaedic Surgical Training

Cited by 20 publications

References 45 publications

Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

Resident Involvement in Arthroscopic Knee Surgery Is Not Associated With Increased Short-term Risk to Patients

The impact of resident involvement on outcomes in orthopedic trauma: An analysis of 20,090 cases

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