Impact of resident involvement in outpatient otolaryngology procedures: An analysis of 17,647 cases

Baker, Andrew B.; Ong, Adrian A.; O’Connell, Brendan P.; Sokohl, Alexander D.; Clinkscales, William B.; Meyer, Ted A.

doi:10.1002/lary.26645

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…Previous studies have reported mixed results regarding the impact of involving trainee surgeons, in a variety of surgical specialties. 7–15,19–24 There have been relatively limited studies in otolaryngology, 1,15–17 especially on the impact of specific procedures. A thorough literature review revealed that the impact of resident participation has only been investigated in open tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…Although the effects of resident participation on hospital charges, patient care and surgical outcome have been investigated across various surgical disciplines, 7–14 including otolaryngology, 15–17 the impact on the outcome of tympanoplasty still remains to be studied. Most recent studies 7–10,14,15 have reported an association between resident involvement and longer operative time.…”

Section: Introductionmentioning

confidence: 99%

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Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

et al. 2020

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ObjectiveThis study aimed to examine the impact of trainee involvement in performing tympanoplasty or tympano-ossiculoplasty on outcomes.MethodsA retrospective analysis was performed of a prospective database of all patients undergoing tympanoplasty and tympano-ossiculoplasty in a single centre during a three-year period. Patients were divided into three primary surgeon groups: consultants, fellows and residents. The outcomes of operative time, surgical complications, length of hospital stay, and air–bone gap improvement were compared among the groups.ResultsThe study included 398 tympanoplasty and tympano-ossiculoplasty surgical procedures, 71 per cent of which were performed by junior trainees (residents). The junior trainee group was associated with a significantly longer surgical time, without adverse impact on outcomes.ConclusionTrainee participation in tympanoplasty and tympano-ossiculoplasty surgery was associated with longer surgical time, but did not negatively affect the peri-operative course or hearing outcome. Therefore, resident involvement in these types of surgery is safe.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

et al. 2020

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“…We adjusted for attending physician reported technical complexity of the procedure, and the sex, age (categorized as ages 25-30 years and ≥31 years), and training level or postgraduate year (junior resident [postgraduate years 1-3], senior resident [postgraduate years 4-7], and fellow) of the trainees. 6,7,21 Based on hypotheses suggested in prior research, 6,7,21 we also modeled modification of the association between ESS score and technical skill by trainee sex, age, and training level. We used the quasi-likelihood under the independence model criterion for model selection.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Sleep deprivation in surgical trainees is associated with cognitive dysfunction, including attention failures and impaired working memory and decision making, 4,5 all of which can adversely affect trainees' performance and learning in the operating room. Resident participation increases the duration of outpatient otolaryngology-head and neck surgical procedures, but does not seem to negatively affect patient outcomes, [6][7][8][9] perhaps owing to adequate supervision.…”

mentioning

confidence: 99%

Association Between Surgical Trainee Daytime Sleepiness and Intraoperative Technical Skill When Performing Septoplasty

Tseng

Vedula

Malpani

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Daytime sleepiness in surgical trainees can impair intraoperative technical skill and thus affect their learning and pose a risk to patient safety. OBJECTIVE To determine the association between daytime sleepiness of surgeons in residency and fellowship training and their intraoperative technical skill during septoplasty. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 19 surgical trainees in otolaryngology-head and neck surgery programs at 2 academic institutions (Johns

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“…If these findings are true, we must consider the possibility that the rise in surgical complications may be a function of resident supervision rather than resident experience or skill. Although numerous studies have determined that resident involvement does not increase surgical morbidity in otolaryngology, there is limited analysis of these trends over time. An increase in resident autonomy may be an unintended consequence of the growing operative volume observed at Oto‐TH in more recent years.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Duty‐Hour Restrictions on Complication Rates Following Major Head and Neck Procedures

et al. 2018

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Objectives/Hypothesis To assess the impact of resident duty‐hour restrictions (DHR) in otolaryngology via comparison of postoperative outcomes between otolaryngology teaching hospitals (Oto‐TH) and nonteaching hospitals (NTH) before and after complete implementation. Study Design Retrospective database review. Methods The Nationwide Inpatient Sample was queried for all major head and neck cases between 2000 and 2002 (n = 34,064) and 2008 and 2010 (n = 33,094). Cases were stratified into Oto‐TH (n = 28,771) and NTH (n = 38,387) and assessed for procedure type, patient comorbidities, and complications. A subpopulation matched by procedure type was generated for direct comparison of complication rates using χ2 and binary logistic regression analyses. Results In the years following DHR, total case volume and average case complexity increased at Oto‐TH only. Using a case‐matched subpopulation, regression analysis found Oto‐TH status to be protective for medical complications both before (odds ratio [OR]: 0.60, P < .001) and after (OR: 0.76, P = .001) DHR. In contrast, Oto‐TH cases had lower risk for surgical complications in 2000 to 2002 (OR: 0.77, P < .001) but not 2008 to 2010 (OR: 1.07, P = .275). When comparing time periods, the years following DHR were associated with a significant decrease in medical complications and mortality across hospital cohorts. For surgical complications, rates significantly improved at NTH only (OR: 0.82, P = .002), with no difference at Oto‐TH (OR: 0.95, P = .450). Conclusions In the years following DHR, rates of medical complications, surgical complications, and mortality have significantly improved at NTH. At Oto‐TH, there has been a lack of similar improvement in surgical complications, even after accounting for increasing case volume and complexity in more recent years. While the cause is likely multifactorial, DHR in otolaryngology residency may play a role. Level of Evidence 4 Laryngoscope, 128:2804–2810, 2018

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Impact of resident involvement in outpatient otolaryngology procedures: An analysis of 17,647 cases

Abstract: 4. Laryngoscope, 127:2026-2032, 2017.

Cited by 12 publications

References 19 publications

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

Association Between Surgical Trainee Daytime Sleepiness and Intraoperative Technical Skill When Performing Septoplasty

The Impact of Duty‐Hour Restrictions on Complication Rates Following Major Head and Neck Procedures

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