title: The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases.
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.
  
  
  METHODS
  II (Prognostic).
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras Street, El Paso, TX, 79920, USA, aschoenf@umich.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Jose A
authors.initials: JA
authors.lastname: Serrano
authors.forename: Brian R
authors.initials: BR
authors.lastname: Waterman
authors.forename: Julia O
authors.initials: JO
authors.lastname: Bader
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D058996:Quality Improvement