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The Effect of Resident Participation on Short-term Outcomes After Orthopaedic Surgery

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The influence of resident involvement on short-term outcomes after orthopaedic surgery is mostly unknown.

Questions/purposes

The purposes of our study were to examine the effects of resident involvement in surgical cases on short-term morbidity, mortality, operating time, hospital length of stay, and reoperation rate and to analyze these parameters by level of training.

Methods

The 2005–2011 American College of Surgeons National Surgical Quality Improvement Program data set was queried using Current Procedural Terminology codes for 66,817 cases across six orthopaedic procedural domains: 28,686 primary total joint arthroplasties (TJAs), 2412 revision TJAs, 16,832 basic and 5916 advanced arthroscopies, 8221 lower extremity traumas, and 4750 spine arthrodeses (fusions). Bivariate and multivariate logistic regression and propensity scores were used to build models of risk adjustment. We compared the morbidity and mortality rates, length of operating time, hospital length of stay, and reoperation rate for cases with or without resident involvement. For cases with resident participation, we analyzed the same parameters by training level.

Results

Resident participation was associated with higher morbidity in TJAs (odds ratio [OR], 1.6; range, 1.4–1.9), lower extremity trauma (OR, 1.3; range, 1.2–1.5), and fusion (OR, 1.4; range, 1.2–1.7) after adjustment. However, resident involvement was not associated with increased mortality. Operative time was greater (all p < 0.001) with resident involvement in all procedural domains. Longer hospital length of stay was associated with resident participation in lower extremity trauma (p < 0.001) and fusion cases (p = 0.003), but resident participation did not affect length of stay in other domains. Resident involvement was associated with greater 30-day reoperation rates for cases of lower extremity trauma (p = 0.041) and fusion (p < 0.001). Level of resident training did not consistently influence surgical outcomes.

Conclusions

Results of our study suggest resident involvement in surgical procedures is not associated with increased short-term major morbidity and mortality after select cases in orthopaedic surgery. Findings of longer operating times and differences in minor morbidity should lead to future initiatives to provide resident surgical skills training and improve perioperative efficiency in the academic setting.

Level of Evidence

Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA

    Andrew J. Pugely MD, Yubo Gao PhD, Christopher T. Martin MD, John J. Callaghan MD, Stuart L. Weinstein MD & J. Lawrence Marsh MD

Authors
  1. Andrew J. Pugely MD
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  2. Yubo Gao PhD
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  3. Christopher T. Martin MD
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  4. John J. Callaghan MD
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  5. Stuart L. Weinstein MD
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  6. J. Lawrence Marsh MD
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Corresponding author

Correspondence to Andrew J. Pugely MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The authors’ institution and one author (AJP) received funding for this study from the Orthopaedic Trauma Association.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Appendix 1. Inclusion CPT codes and frequency

Appendix 1. Inclusion CPT codes and frequency

Variable

CPT code

Frequency

Percentage

Primary total joint arthroplasty

 

27447

10,207

35.58

 

27130

18,479

64.42

Revision total joint arthroplasty

 

27134

843

34.95

 

27137

373

15.46

 

27138

142

5.89

 

27487

1054

43.70

Basic arthroscopy

 

29806

618

3.67

 

29807

790

4.69

 

29819

31

0.18

 

29820

28

0.17

 

29821

50

0.30

 

29824

415

2.47

 

29825

123

0.73

 

29826

2620

15.57

 

29828

78

0.46

 

29873

261

1.55

 

29874

167

0.99

 

29875

492

2.92

 

29876

358

2.13

 

29877

999

5.94

 

29879

477

2.83

 

29880

2299

13.66

 

29881

6572

39.04

 

29882

261

1.55

 

29883

57

0.34

 

29884

98

0.58

 

29885

4

0.02

 

29886

9

0.05

 

29887

25

0.15

Advanced arthroscopy

 

27403

1

0.02

 

27405

1

0.02

 

27407

1

0.02

 

27418

1

0.02

 

27427

1

0.02

 

27428

4

0.07

 

27429

1

0.02

 

27447

1

0.02

 

27599

1

0.02

 

27881

1

0.02

 

29827

2674

45.20

 

29868

2

0.03

 

29876

1

0.02

 

29877

2

0.03

 

29879

2

0.03

 

29880

35

0.59

 

29881

83

1.40

 

29882

16

0.27

 

29883

3

0.05

 

29888

3077

52.01

 

29889

8

0.14

Lower extremity trauma

 

27235

615

7.481

 

27236

1655

20.131

 

27244

772

9.391

 

27245

1534

18.660

 

27506

340

4.136

 

27759

327

3.978

 

27766

204

2.481

 

27769

15

0.182

 

27792

775

9.427

 

27814

888

10.802

 

27822

506

6.155

 

27823

131

1.593

 

27826

21

0.255

 

27827

146

1.776

 

27828

152

1.849

 

27829

140

1.703

Spine

 

22551

116

2.44

 

22554

530

11.16

 

22558

381

8.02

 

22590

10

0.21

 

22595

25

0.53

 

22600

108

2.27

 

22610

76

1.60

 

22612

1232

25.94

 

22614

117

2.46

 

22630

481

10.13

 

22800

22

0.46

 

22842

34

0.72

 

22851

16

0.34

 

63001

37

0.78

 

63003

12

0.25

 

63012

33

0.69

 

63015

21

0.44

 

63020

51

1.07

 

63030

1366

28.76

 

63040

11

0.23

 

63045

71

1.49

  1. CPT = Current Procedural Terminology.

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Pugely, A.J., Gao, Y., Martin, C.T. et al. The Effect of Resident Participation on Short-term Outcomes After Orthopaedic Surgery. Clin Orthop Relat Res 472, 2290–2300 (2014). https://doi.org/10.1007/s11999-014-3567-0

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  • DOI: https://doi.org/10.1007/s11999-014-3567-0

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