title: Does resident involvement have an impact on postoperative complications after total shoulder arthroplasty? An analysis of 1382 cases.
abstract: BACKGROUND
  The impact of resident involvement on total shoulder arthroplasty (TSA) complication rate is unknown. The purpose of this study was to assess whether resident involvement in TSA is associated with 30-day complication rates.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was searched for all patients who underwent TSA between 2005 and 2012. Data were extracted for patient preoperative demographics, intraoperative variables, resident involvement in surgery, and 30-day postoperative complications. Resident and nonresident cases were grouped by a matched propensity score analysis. Univariate and multivariate analysis was performed to assess the effect of resident involvement on postoperative complications.
  
  
  RESULTS
  We analyzed 1382 patients who underwent primary TSA, with matched groups of 691 with and 691 without resident involvement. The overall rate of 30-day complications was 2.60% in TSAs in which a resident was involved compared with 3.91% when no resident was involved (P = .173). Operative time and hospital stay were shorter in cases in which a resident was present (P = .002 and P < .001, respectively). Independent risk factors significantly associated with TSA complications identified by multivariate regression were higher patient age, higher American Society of Anesthesiologists classification, congestive heart failure, insulin-dependent diabetes, and peripheral vascular disease.
  
  
  CONCLUSIONS
  Resident involvement in TSA procedures is not a risk factor for 30-day complications. Patient factors including increased age, diabetes, and cardiac disease are risk factors for TSA complications. This information can be used in preoperative counseling to reassure patients about safety of resident involvement in TSA and to optimize patient comorbidities before surgery.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: Gregory.cvetanovich@gmail.com.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Cvetanovich
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Haughom
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nicholson
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D000367:Age Factors; D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery*
keywords: NSQIP; Total shoulder arthroplasty; complications; resident involvement