title: Impact of Resident Involvement on Orthopaedic Surgery Outcomes: An Analysis of 30,628 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database.
abstract: BACKGROUND
  Operative procedural training is a key component of orthopaedic surgery residency. The influence of intraoperative resident participation on the outcomes of surgery has not been studied extensively using large, population-based databases.
  
  
  METHODS
  We identified 30,628 patients who underwent orthopaedic procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program. Outcomes as measured by perioperative complications, readmission rates, and mortality within thirty days were compared for cases with and without intraoperative resident involvement.
  
  
  RESULTS
  Logistic regression with propensity score analysis revealed that intraoperative resident participation was associated with decreased rates of overall complications (odds ratio, 0.717 [95% confidence interval, 0.657 to 0.782]), medical complications (odds ratio, 0.723 [95% confidence interval, 0.661 to 0.790]), and mortality (odds ratio, 0.638 [95% confidence interval, 0.427 to 0.951]). Resident presence in the operating room was not predictive of wound complications (odds ratio, 0.831 [95% confidence interval, 0.656 to 1.053]), readmission (odds ratio, 0.962 [95% confidence interval, 0.830 to 1.116]), or reoperation (odds ratio, 0.938 [95% confidence interval, 0.758 to 1.161]). A second analysis by propensity score stratification into quintiles grouped by similar probability of intraoperative resident presence showed resident involvement to correlate with decreased rates of overall and medical complications in three quintiles, but increased rates of overall and medical complications in one quintile. All other outcomes were equivalent across quintiles.
  
  
  CONCLUSIONS
  Orthopaedic resident involvement during surgical procedures is associated with lower risk of perioperative complications and mortality in the National Surgical Quality Improvement Program database. The results support resident participation in the operative care of orthopaedic patients.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim: jokim@nmh.org.
authors.forename: Adam I
authors.initials: AI
authors.lastname: Edelstein
authors.affiliation: Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim: jokim@nmh.org.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Lovecchio
authors.affiliation: Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim: jokim@nmh.org.
authors.forename: Sujata
authors.initials: S
authors.lastname: Saha
authors.affiliation: Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim: jokim@nmh.org.
authors.forename: Wellington K
authors.initials: WK
authors.lastname: Hsu
authors.affiliation: Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim: jokim@nmh.org.
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards*; D009985:Orthopedics / Q000193:education*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D058996:Quality Improvement; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States