title: The impact of surgical trainee participation on sinus surgery outcomes.
abstract: OBJECTIVE
  To determine the effect of otolaryngology trainee participation on clinical outcomes in patients who undergo endoscopic sinus surgery (ESS) for chronic rhinosinusitis.
  
  
  METHODS
  Secondary analysis of prospectively collected data.
  
  
  METHODS
  Patients enrolled in a sinus surgery outcomes study between May 2011 and March 2013 were stratified into two groups--those who were operated on by an attending alone and those operated on by an attending with a trainee present (resident, fellow, or both). Patients completed quality of life (QOL) surveys including the Chronic Sinusitis Survey (CSS), 22-item Sino-Nasal Outcome Test (SNOT-22), and EuroQol 5-dimension survey preoperatively and 1 year postoperatively. Operative time, estimated blood loss (EBL), complication rates, and survey scores were compared between groups.
  
  
  RESULTS
  The study population consisted of 452 patients. The attending alone (n = 119) and trainee (n = 333) groups were statistically comparable in terms of patient demographics, disease severity, and extent of surgery. Mean operative time was significantly shorter in the attending-alone group (80.0 vs. 90.6 minutes, P < .01). Mean EBL (105 mL attending vs. 117 mL trainee, P = .39) and complication rates (3.3% attending vs. 0.6% trainee, P = .07) were similar between groups. Observed changes in QOL measures following ESS were comparable between groups, although absolute improvement in the SNOT-22 scores (19.0 attending vs. 24.5 trainee, P = .05) did show a trend toward greater improvement in the trainee group.
  
  
  CONCLUSIONS
  Trainee participation in ESS is associated with prolongation in surgical time; however, such participation was not found to adversely affect patient safety or clinical outcomes.
  
  
  METHODS
  2b.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Josh C
authors.initials: JC
authors.lastname: Meier
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Remenschneider
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Holbrook
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Gliklich
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
mesh_terms: D004502:Education, Medical, Continuing / Q000379:methods*; D005180:Faculty, Medical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010036:Otolaryngology / Q000193:education*; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Quality of life; adult rhinology; allergy/rhinology; outcomes/cost-effectiveness