Skip to main content

Advertisement

SpringerLink
Log in

The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Few studies have addressed the role of residents’ participation in morbidity and mortality after orthopaedic surgery. The present study utilized the 2005–2010 National Surgical Quality Improvement Program (NSQIP) dataset to assess the risk of 30-day post-operative complications and mortality associated with resident participation in orthopaedic procedures.

Methods

The NSQIP dataset was queried using codes for 12 common orthopaedic procedures. Patients identified as having received one of the procedures had their records abstracted to obtain demographic data, medical history, operative time, and resident involvement in their surgical care. Thirty-day post-operative outcomes, including complications and mortality, were assessed for all patients. A step-wise multivariate logistic regression model was constructed to evaluate the impact of resident participation on mortality- and complication-risk while controlling for other factors in the model. Primary analyses were performed comparing cases where the attending surgeon operated alone to all other case designations, while a subsequent sensitivity analysis limited inclusion to cases where resident participation was reported by post-graduate year.

Results

In the NSQIP dataset, 43,343 patients had received one of the 12 orthopaedic procedures queried. Thirty-five percent of cases were performed with resident participation. The mortality rate, overall, was 2.5 and 10 % sustained one or more complications. Multivariate analysis demonstrated a significant association between resident participation and the risk of one or more complications [OR 1.3 (95 % CI 1.1, 1.4); p < 0.001] as well as major systemic complications [OR 1.6 (95 % CI 1.3, 2.0); p < 0.001] for primary joint arthroplasty procedures only. These findings persisted even after sensitivity testing.

Conclusions

A mild to moderate risk for complications was noted following resident involvement in joint arthroplasty procedures. No significant risk of post-operative morbidity or mortality was appreciated for the other orthopaedic procedures studied.

Level of evidence

II (Prognostic).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gawande A (2002) Complications: A surgeon’s notes on an imperfect science. Metropolitan Books, New York

    Google Scholar 

  2. Cameron JL (1997) William Stewart Halstead: our surgical heritage. Ann Surg 225:445–458

    Article  PubMed  CAS  Google Scholar 

  3. Davis SS Jr, Husain FA, Lin E, Nandipati KC, Perez S, Sweeney JF (2012) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg (E-pub ahead of print)

  4. Emery SE, Guss D, Kuremsky MA, Hamlin BR, Herndon JH, Rubash HE (2012) Resident education versus fellowship training—conflict or synergy? J Bone Jt Surg Am 94:e1591–e1598

    Article  Google Scholar 

  5. Raval MV, Wang X, Cohen ME, Ingraham AM, Bentrem DJ, Dimick JB, Flynn T, Hall BL, Ko CY (2011) The influence of resident involvement on surgical outcomes. J Am Coll Surg 212:889–898

    Article  PubMed  Google Scholar 

  6. Englesbe MJ, Fan Z, Baser O, Birkmeyer JD (2009) Mortality in medicare patients undergoing surgery in July in teaching hospitals. Ann Surg 249:871–876

    Article  PubMed  Google Scholar 

  7. Englesbe MJ, Pelletier SJ, Magee JC, Gauger P, Schifftner T, Henderson WG, Khuri SF, Campbell DA (2007) Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg 246:456–462

    Article  PubMed  Google Scholar 

  8. Advani V, Ahad S, Gonczy C, Markwell S, Hassan I (2012) Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16, 849 cases from the ACS-NSQIP. Am J Surg 20:347–352

    Article  Google Scholar 

  9. Bukur M, Singer MB, Chung R, Ley EJ, Malinoski DJ, Margulies DR, Salim A (2012) Influence of resident involvement on trauma care outcomes. Arch Surg 147:856–862

    Article  PubMed  Google Scholar 

  10. Cowles RA, Moyer CA, Sonnad SS, Simeone DM, Knol JA, Eckhauser FE, Mulholland MW, Colletti LM (2001) Doctor-patient communication in surgery: attitudes and expectations of general surgery patients about the involvement and education of surgical residents. J Am Coll Surg 193:73–80

    Article  PubMed  CAS  Google Scholar 

  11. Dutta S, Dunningham G, Blanchard MC, Spielman B, Da Rosa D, Joehl RH (2003) And doctor, no residents please! J Am Coll Surg 197:1012–1017

    Article  PubMed  Google Scholar 

  12. Fahrner R, Turina M, Neuhaus V, Schob O (2012) Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients. Langenbecks Arch Surg 397:103–110

    Article  PubMed  Google Scholar 

  13. Hwang CS, Pagano CR, Wichterman KA, Dunnington GL, Alfrey EJ (2008) Resident versus no resident: a single institutional study on operative complications, mortality, and cost. Surgery 144:339–344

    Article  PubMed  Google Scholar 

  14. Jan A, Riggs DR, Orlando KL, Khan FJ (2012) Surgical outcomes based on resident involvement: what is the impact on vascular surgery patients? J Surg Educ 69:638–642

    Article  PubMed  Google Scholar 

  15. Kazaure HS, Roman SA, Sosa JA (2012) The resident as surgeon: an analysis of ACS-NSQIP. J Surg Res 178:126–132

    Article  PubMed  Google Scholar 

  16. Reeves JG, Kasirajan K, Veeraswamy RK, Ricotta JJ II, Salam AA, Dodson TF, McClusky DA III, Corriere MA (2012) Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes. J Vasc Surg 55:268–273

    Article  PubMed  Google Scholar 

  17. Belmont PJ Jr, Davey S, Orr JD, Ochoa LM, Bader JO, Schoenfeld AJ (2011) Risk factors for 30-day post-operative complications and mortality after below-knee amputation: a study of 2,911 patients from the National Surgical Quality Improvement Program. J Am Coll Surg 213:370–378

    Article  PubMed  Google Scholar 

  18. Schoenfeld AJ, Ochoa LM, Bader JO, Belmont PJ Jr (2011) Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Jt Surg Am 93:1577–1582

    Article  Google Scholar 

  19. Accreditation Council for Graduate Medical Education (2011). Development of orthopaedic surgery minimum number requirements. RRC news for orthopaedic surgery Aug 2, 2011

  20. Martin KD, Cameron K, Belmont PJ, Schoenfeld A, Owens BD (2012) Shoulder arthroscopy simulator performance correlates with resident and shoulder arthroscopy experience. J Bone Jt Surg Am 94:e1601–e1605

    Article  Google Scholar 

  21. Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon. Am J Sports Med 36:1618–1624

    Article  PubMed  Google Scholar 

  22. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265

    Article  PubMed  CAS  Google Scholar 

  23. Khatod M, Inacio M, Paxton EW, Bini SA, Namba RS, Burchette RJ, Fithian DC (2008) Knee replacement: epidemiology, outcomes, and trends in Southern California. Acta Orthop 79:812–819

    Article  PubMed  Google Scholar 

  24. Laxdal G, Kartus J, Ejerhed L, Sernert N, Magnusson L, Faxén E, Karlsson J (2005) Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy 21:958–964

    Article  PubMed  Google Scholar 

  25. Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA (2003) Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Jt Surg Am 85:27–32

    Google Scholar 

  26. Quinn J, Cummings S, Callaham M, Sellers K (2002) Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ 325:299

    Article  PubMed  Google Scholar 

  27. Singh JA, Kundukulam J, Riddle DL, Strand V, Tugwell P (2011) Early postoperative mortality following joint arthroplasty: a systematic review. J Rheumatol 38:1507–1513

    Article  PubMed  Google Scholar 

  28. Singh JA, Lewallen DG (2012) Ninety-day mortality in patients undergoing elective total hip or total knee arthroplasty. J Arthroplasty 27:1417–1422.e1

    Article  PubMed  Google Scholar 

  29. Smith DG, Fergason JR (1999) Transtibial amputations. Clin Orthop Relat Res 361:108–115

    Article  PubMed  Google Scholar 

  30. Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy: closing- versus opening-wedge methods. J Bone Jt Surg Br 92:1245–1252

    CAS  Google Scholar 

  31. Strum GM, Friedman MJ, Fox JM, Ferkel RD, Dorey FH, Del Pizzo W, Snyder SJ (1990) Acute anterior cruciate ligament reconstruction. Analysis of complications. Clin Orthop Relat Res 253:184–189

    PubMed  Google Scholar 

  32. Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the spine patient outcomes research trial (SPORT). Spine 33:2789–2800

    Article  PubMed  Google Scholar 

  33. Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA (2007) Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Jt Surg Am 89:526–533

    Article  Google Scholar 

  34. Auerbach JD, Lonner BS, Antonacci MD, Kean KE (2008) Perioperative outcomes and complications related to teaching residents and fellows in scoliosis surgery. Spine 33:1113–1118

    Article  PubMed  Google Scholar 

  35. Banco SP, Vaccaro AR, Blam O, Eck JC, Cotler JM, Hilibrand AS, Albert TJ, Murphey S (2002) Spine infections: variations in incidence during the academic year. Spine 27:962–965

    Article  PubMed  Google Scholar 

  36. Lavernia CJ, Sierra RJ, Hernandez RA (2000) The cost of teaching total knee arthroplasty surgery to orthopaedic surgery residents. Clin Orthop Relat Res 380:99–107

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras Street, El Paso, TX, 79920, USA

    Andrew J. Schoenfeld, Jose A. Serrano, Brian R. Waterman & Philip J. Belmont Jr.

  2. Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA

    Julia O. Bader

Authors
  1. Andrew J. Schoenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose A. Serrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian R. Waterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julia O. Bader
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip J. Belmont Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew J. Schoenfeld.

Additional information

Some authors are employees of the U.S. Federal Government and the United States Army. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of William Beaumont Army Medical Center, the Department of Defense, or United States government. The National Surgical Quality Improvement Program remains the full and exclusive property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schoenfeld, A.J., Serrano, J.A., Waterman, B.R. et al. The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg 133, 1483–1491 (2013). https://doi.org/10.1007/s00402-013-1841-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1841-3

Keywords

Search

Navigation