title: The effect of resident participation on short-term outcomes after orthopaedic surgery.
abstract: BACKGROUND
  The influence of resident involvement on short-term outcomes after orthopaedic surgery is mostly unknown.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.forename: John J
authors.initials: JJ
authors.lastname: Callagh
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Weinstein
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Marsh
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000193:education; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000193:education; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000193:education* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D057216:Propensity Score; D012086:Reoperation; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000193:education; D013997:Time Factors; D016896:Treatment Outcome