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Surgical resident involvement in foot and ankle surgery.

Publication ,  Journal Article
Gross, CE; Chang, D; Adams, SB; Parekh, SG; Bohnen, JD
Published in: Foot Ankle Surg
December 2017

BACKGROUND: Surgical resident participation in the operating room is necessary for education and progression toward safe and independent practice. However, the impact of resident involvement on patient outcomes in foot and ankle surgery is unknown. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2012) was used to identify common foot and ankle procedures (by Current Procedural Taxonomy (CPT) code) performed by orthopedic surgeons. Resident participation was determined using the NSQIP-collected variable 'pgy'; cases missing the pgy variable were excluded. Multivariate regression models were constructed to determine an association between resident involvement and 30-day morbidity (total, medical, and surgical complications) and 30-day mortality, when controlling for patient demographics, comorbidities, American Society for Anesthesiologist (ASA) status, body mass index (BMI), and smoking status. RESULTS: A total of 13,685 cases were analyzed for 24 common foot and ankle operations. Overall mortality rate was 3.60%. Overall complication rate was 16.9%; 10.9% had medical and 8.3% had surgical complications. Residents were involved in 55.6% of cases. In unadjusted analyses, resident cases were less likely to be emergent, but were performed on more complicated patients (i.e. higher comorbidity burden, higher ASA scores). Resident cases had increased total morbidity (18.8% vs. 14.6%, p<0.001), medical complications (12.5% vs. 9.0%, p<0.001), and surgical complications (8.7% vs. 7.7%, p=0.03), but similar mortality frequency (3.8% vs. 3.3%, p=0.2). In multivariable analyses, resident cases did not correlate with 30-day mortality, 30-day total morbidity, or 30-day surgical complications; resident cases were, however, associated with increased medical complications [Odds Ratio (OR) 1.18 (95% Confidence Interval (CI) 1.02-1.37, p=0.03)] and longer length of stay [Coeff 2.38 (1.68-3.09), p<0.001]. Subgroup analyses of orthopedic-only cases demonstrated no statistical association between resident involvement and mortality, total morbidity, or medical complications; a decrease in surgical complications was observed for open reduction internal fixation cases [OR 0.23 (0.06-0.82), p=0.02]. CONCLUSIONS: Resident involvement in foot and ankle surgery is not associated with changes in 30-day mortality, 30-day total morbidity, or 30-day surgical complication rates. Residents operate on more medically complex patients who experience higher medical complication rates and longer postoperative length of stay; however, the cause and directionality of this relationship remains to be determined. Efforts to improve the quality of foot and ankle surgery with resident involvement should target reductions in post-operative medical complications. LEVEL OF EVIDENCE: Prognostic study, Level II.

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Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

December 2017

Volume

23

Issue

4

Start / End Page

261 / 267

Location

France

Related Subject Headings

  • Orthopedics
  • Orthopedics
  • Orthopedic Procedures
  • Internship and Residency
  • Humans
  • Foot
  • Clinical Competence
  • Ankle
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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ICMJE
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Gross, C. E., Chang, D., Adams, S. B., Parekh, S. G., & Bohnen, J. D. (2017). Surgical resident involvement in foot and ankle surgery. Foot Ankle Surg, 23(4), 261–267. https://doi.org/10.1016/j.fas.2016.08.001
Gross, Christopher E., David Chang, Samuel B. Adams, Selene G. Parekh, and Jordan D. Bohnen. “Surgical resident involvement in foot and ankle surgery.Foot Ankle Surg 23, no. 4 (December 2017): 261–67. https://doi.org/10.1016/j.fas.2016.08.001.
Gross CE, Chang D, Adams SB, Parekh SG, Bohnen JD. Surgical resident involvement in foot and ankle surgery. Foot Ankle Surg. 2017 Dec;23(4):261–7.
Gross, Christopher E., et al. “Surgical resident involvement in foot and ankle surgery.Foot Ankle Surg, vol. 23, no. 4, Dec. 2017, pp. 261–67. Pubmed, doi:10.1016/j.fas.2016.08.001.
Gross CE, Chang D, Adams SB, Parekh SG, Bohnen JD. Surgical resident involvement in foot and ankle surgery. Foot Ankle Surg. 2017 Dec;23(4):261–267.
Journal cover image

Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

December 2017

Volume

23

Issue

4

Start / End Page

261 / 267

Location

France

Related Subject Headings

  • Orthopedics
  • Orthopedics
  • Orthopedic Procedures
  • Internship and Residency
  • Humans
  • Foot
  • Clinical Competence
  • Ankle
  • 3202 Clinical sciences
  • 1103 Clinical Sciences