title: Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness: a teaching hospital-based propensity score analysis.
abstract: BACKGROUND
  Postoperative throat complications, such as sore throat and hoarseness, are frequent complications of tracheal intubation. To assess whether severity of throat complications is related to the experience of physicians performing tracheal intubation, we compared the incidence and duration of postoperative sore throat and hoarseness and patient satisfaction between tracheal intubation performed by trainees and experienced consultant anaesthetists.
  
  
  METHODS
  This is a retrospective review of an institutional registry containing records of 21 606 patients undergoing general anaesthesia and was conducted with ethics board approval. All tracheal intubations by trainees were performed under the supervision of consultant anaesthetists. To avoid channel bias, the propensity score analysis was used to generate a set of matched cases (intubations by trainees) and controls (intubations by anaesthetists), yielding 3465 (sore throat) and 3267 (hoarseness) matched patient pairs. The incidence and sustained rate of symptoms were compared as primary outcomes. We also compared patient satisfaction with perioperative care.
  
  
  RESULTS
  After propensity score matching, there was no difference between tracheal intubation by trainees and tracheal intubation by consultant anaesthetists in the incidences of sore throat (32.9 vs 32.6%, P=0.84) or hoarseness (35.8 vs 35.2%, P=0.60). Odds ratios and 95% confidence intervals for tracheal intubation by trainees were 1.01 (0.91-1.12) for sore throat and 1.03 (0.93-1.14) for hoarseness. The rates of sustained sore throat and hoarseness over the course were low (P=0.85 and P=0.67, respectively). Hazard ratios and 95% confidence intervals for tracheal intubation by trainees were 0.99 (0.94-1.05) for sustained sore throat and 0.99 (0.93-1.05) for sustained hoarseness. Patient satisfaction did not differ between matched groups (P=0.66 and P=0.83).
  
  
  CONCLUSIONS
  Tracheal intubation by trainees under the supervision of consultant anaesthetists did not worsen the postoperative airway outcomes, such as sore throat and hoarseness.
authors.affiliation: Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8522, Japan seninoue@naramed-u.ac.jp.
authors.forename: S
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8522, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Abe
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8522, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8522, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kawaguchi
mesh_terms: D000368:Aged; D000776:Anesthesiology / Q000193:education; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006685:Hoarseness / Q000453:epidemiology*; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010612:Pharyngitis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: airway, complications; complications, tracheal intubation; education, untrained personnel