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

Mitchell, Phillip M.; Гаврилова, С.А.; Dodd, Ashley C.; Attum, Basem; Obremskey, William T.; Sethi, Manish K.

doi:10.1016/j.jcot.2016.02.002

Cited by 21 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior investigations have evaluated the effect of resident participation on postoperative outcomes using the NSQIP database in the areas of arthroplasty, arthroscopy, and spinal arthrodesis. [8][9][10][11][12][13][14][15] These studies support our findings and suggest that resident involvement does not have an adverse impact on patient outcomes across various orthopaedic surgical procedures. Analyses of both primary total hip and knee arthroplasty procedures concluded that resident participation was not associated with higher morbidity or mortality despite an increase in operative time, and found no difference in complication rates based on resident level of training.…”

Section: Discussionsupporting

confidence: 84%

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

et al. 2019

View full text Add to dashboard Cite

Hands-on participation in the operating room (OR) is an integral component of surgical resident training. However, the implications of resident involvement in many orthopaedic procedures are not well defined. This study aims to assess the effect of resident involvement on short-term outcomes following anterior cruciate ligament reconstruction (ACLR). The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent ACLR from 2005 to 2012. Demographic variables, resident participation, 30-day complications, and intraoperative time parameters were assessed for all cases. Resident and nonresident cases were matched using propensity scores. Outcomes were analyzed using univariate and multivariate regression analyses, as well as stratified by resident level of training. Univariate analysis of 1,222 resident and 1,188 nonresident cases demonstrated no difference in acute postoperative complication rates between groups. There was no significant difference in the incidence of overall complications based on resident level of training (p = 0.109). Operative time was significantly longer for cases in which a resident was involved (109.5 vs. 101.7 minutes; p < 0.001). Multivariate analysis identified no significant predictors of major postoperative complications, while patient history of chronic obstructive pulmonary disease was the only independent risk factor associated with minor complications. Resident involvement in ACLR was not associated with 30-day complications despite a slight increase in operative time. These findings provide reassurance that resident involvement in ACLR procedures is safe, although future investigations should focus on long-term postoperative outcomes.

show abstract

Section: Discussionsupporting

confidence: 84%

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The impact of resident involvement in surgical procedures has been explored in various surgical and orthopaedic procedures. 15 16 17 18 19 20 21 22 Haughom et al 21 performed a retrospective analysis on the impact of residents involved in total hip arthroplasty 20 and total knee arthroplasty cases. These two studies did not identify resident involvement as a risk factor for 30-day morbidity or mortality in these selected cases.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Resident Involvement on Postoperative Complications After Shoulder Arthroscopy: A Propensity-Matched Analysis

et al. 2020

View full text Add to dashboard Cite

Purpose: Shoulder arthroscopy is the second most frequently performed procedure by orthopaedic surgeons taking the American Board of Orthopaedic Surgery part II examination. However, the impact of resident involvement on outcomes after shoulder arthroscopy is poorly understood. The aim of this study was to investigate whether resident involvement in shoulder arthroscopic procedures affects postoperative complication rates and surgical time using propensity score-matched cohorts. Methods: The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent common shoulder arthroscopic procedures between 2006 and 2012. Cases without information on resident involvement, treatment of septic arthritis or osteomyelitis of the shoulder, or concomitant open or miniopen procedures were excluded from the study. A 1:1 propensity score match was used based on demographic and comorbidity factors to match cases with resident involvement to nonresident cases. Patient demographics, comorbidities, surgical time, length of hospital stay, and 30-day postoperative complications were compared between the two groups. Results: Overall, 15,857 patients who underwent shoulder arthroscopy were identified. After propensity score matching, 3474 cases (50% with resident involvement) were included. Appropriate matching was verified with no difference in demographic or health characteristics. No significant differences in the overall rate of 30-day complications was noted in resident-involved versus nonresident group ( P = 0.576). No significant difference was observed in postoperative surgical or medical complications. Resident involvement was significantly longer surgical time (75.9 ± 35.9 versus 75.1 ± 40.5 minutes, P = 0.03) when compared with cases performed without a resident. Conclusions: Resident involvement in shoulder arthroscopy is not associated with increased risk for medical or surgical 30-day postoperative complications. Resident participation in shoulder arthroscopy cases did increase surgical time; however, this finding is likely clinically insignificant.

show abstract

“…These results suggest that technical difficulty may play a role, given that RCR and ACLR represent operations with specialized equipment that may vary based on provider and institution preferences. Although a variety of studies have previously used the American College of Surgeons NSQIP database to examine the impact of resident involvement in orthopaedics, most focused on complication rates and safety, 20,24,[44][45][46][47][48][49] and few studies have examined procedures common in sports medicine. 27,50,51 Basques et al 27 examined the role of resident involvement in shoulder arthroscopy, reporting no change in operative time between attending-only cases and resident-involved cases.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas some studies have reported a lower or equal risk of perioperative complications and associations with care for more medically complex patients, others have reported longer operating times, greater morbidity, and longer hospital stay durations. 20,[23][24][25][26] The impact of resident involvement in academic sports medicine is particularly poorly studied, with few studies examining complications, safety, or operative time 27,28 and only a single study using this data to estimate the cost of resident involvement in rotator cuff surgery. 29 For the aforementioned reasons, the purpose of this study is to quantify the cost of resident involvement in academic sports medicine by examining differences in operative time, relative value units (RVUs) per case, and RVUs per hour between attending-only cases and cases with resident involvement.…”

mentioning

confidence: 99%

Quantifying the Opportunity Cost of Resident Involvement in Academic Orthopaedic Sports Medicine: A Matched-Pair Analysis

Beletsky

Manderle

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Purpose: To quantify the cost of resident involvement in academic sports medicine by examining differences in operative time, relative value units (RVUs) per case, and RVUs per hour between attending-only cases and cases with resident involvement. Methods: A retrospective analysis of common sports medicine procedures identified by Current Procedural Terminology code was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2015. Matched cohorts were generated based on demographic variables, comorbidities, preoperative laboratory values, and surgical procedures. Bivariate analysis examined mean differences in operative time, RVUs per case, and RVUs per hour between attending-only cases and cases with resident involvement. A cost analysis was performed to quantify differences in RVUs generated per hour in terms of dollars per case. Results: A total of 14,840 attending-only cases and 2,230 residentinvolved cases were used to generate 2 matched cohorts (N ¼ 4,460). Resident cases had greater mean operative times than attending-only cases, with operative time increasing as residents became more senior (P < .01). Residents participated in cases with larger mean RVUs per case (P < .01). Cases with lone attendings showed greater RVUs per hour (P < .01). The cost of resident involvement increased nearly 8-fold from postgraduate year 1 to postgraduate year 6 residents ($25.70 vs $200.07). Conclusions: In academic sports medicine, the involvement of resident physicians increases operative time. The associated decrease in attending physician efficiency in RVUs per hour equates to an average cost per case of $159.18, with costs increasing as residents become more senior. Level of Evidence: Level III, retrospective comparative trial. See commentary on page 842A merican health industry expenditures doubled from 1980 to 2017, and although recent studies have reported a slowing in the growth of the health care industry, projections continue to estimate 3% yearly growth that exceeds any other industry. 1,2 Value-based care has been introduced as a structural concept to help optimize American health care delivery by testing new payment models rather than traditional fee-for-service structures used by Medicare. 3,4 Through a combination of bundled-care payment structures, improved care delivery systems, and incentivizing toward higher-value care, value-based care seeks to unite the multiple stakeholders involved in health care toward maximizing positive outcomes per dollar spent. [5][6][7][8] The emphasis on redefining value in American health care has ushered in a new wave of cost analyses aimed at quantifying surgical costs in relation to the qualityadjusted life-years gained by patients. 6,[9][10][11][12]

show abstract

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

Cited by 21 publications

References 17 publications

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

The Impact of Resident Involvement on Postoperative Complications After Shoulder Arthroscopy: A Propensity-Matched Analysis

Quantifying the Opportunity Cost of Resident Involvement in Academic Orthopaedic Sports Medicine: A Matched-Pair Analysis

Contact Info

Product

Resources

About