title: Impact of Resident Participation on Outcomes After Single-Level Anterior Cervical Diskectomy and Fusion: An Analysis of 3265 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database.
abstract: METHODS
  Multicenter retrospective cohort study.
  
  
  OBJECTIVE
  To investigate the relationship between resident involvement in the operating room and 30-day complication rates in patients undergoing single-level anterior cervical diskectomy and fusion (ACDF).
  
  
  BACKGROUND
  Although an integral part of academic medicine, surgical resident participation in the operating room and its impact on patient outcomes have been a topic of debate. No large-scale study has been performed to examine this relationship in ACDF.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed to identify all patients who underwent single-level ACDF procedures during 2006-2013. A propensity score-matching algorithm was employed to minimize baseline differences. Multivariate logistic regression analysis of unadjusted and propensity-matched cohorts was performed to examine the effect of resident participation on 30-day postoperative complication rates and length of hospital stay.
  
  
  RESULTS
  A total of 3265 patients met inclusion criteria. The propensity score-matching procedure yielded 1003 pairs of well-matched nonresident and resident pairs. The multivariate analysis of propensity score-matched population demonstrated that resident involvement was not associated with an increased risk for any of the complications analyzed, including overall complications, medical complications, surgical complications, mortality, cardiac arrest, deep venous thrombosis, or length of total hospital stay.
  
  
  CONCLUSIONS
  This large-scale, population-based study found that surgical resident participation in the operating room did not increase the risk of 30-day complications nor prolonged the length of hospital stay. Resident participation, however, was associated with an increased operative duration. Strategies to improve residents' technical proficiency outside of the operating room may enhance patient safety.
  
  
  METHODS
  3.
authors.affiliation: *Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL †Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Kim
authors.forename: Roxanna M
authors.initials: RM
authors.lastname: Garcia
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Smith
authors.forename: Nader S
authors.initials: NS
authors.lastname: Dahdaleh
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual / Q000592:standards* / Q000639:trends; D017586:Diskectomy / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000592:standards* / Q000639:trends; D066231:Surgeons / Q000592:standards* / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology