title: The impact of resident involvement on outcomes in orthopedic trauma: An analysis of 20,090 cases.
abstract: BACKGROUND
  Involvement in patient care is critical in training orthopedic surgery residents for independent practice. As the focus on outcomes and quality measures intensifies, the impact of resident intraoperative involvement on patient outcomes will be increasingly scrutinized. We sought to determine the impact of residents' intraoperative participation on 30-day post-operative outcomes in the orthopedic trauma population.
  
  
  METHODS
  A total of 20,090 patients from the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2013 were identified. Patient demographics and comorbidities, surgical variables, and 30-day post-operative (wound, minor, and major) complications were collected. Chi-squared and analysis of variance statistical methods were used to compare the 30-day outcomes of patients with and without a resident's intraoperative involvement.
  
  
  RESULTS
  Resident involvement had no effect in the incidence of wound and minor complications among all three anatomic sites of orthopedic trauma procedures (hip, lower extremity [LE], and upper extremity [UE]). There was no statistically significant difference in the incidence of major complications in the hip and LE groups. The UE group, however, demonstrated an increase in the rate of major complications (2.60% vs. 1.89%,p= 0.046). There was no difference in mortality or readmission rates.
  
  
  CONCLUSIONS
  Resident involvement in orthopedic trauma cases did not significantly impact the 30-day outcomes in nearly all domains. Our findings support continued resident involvement in the care of the orthopedic trauma patient.
authors.affiliation: The Vanderbilt Orthopaedic Institute for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232-8774, United States.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Mitchell
authors.affiliation: The Vanderbilt Orthopaedic Institute for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232-8774, United States.
authors.forename: Svetlana A
authors.initials: SA
authors.lastname: Gavrilova
authors.affiliation: The Vanderbilt Orthopaedic Institute for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232-8774, United States.
authors.forename: Ashley C
authors.initials: AC
authors.lastname: Dodd
authors.affiliation: The Vanderbilt Orthopaedic Institute for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232-8774, United States.
authors.forename: Basem
authors.initials: B
authors.lastname: Attum
authors.affiliation: The Vanderbilt Orthopaedic Institute for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232-8774, United States.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: The Vanderbilt Orthopaedic Institute for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232-8774, United States.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
keywords: Complication; Operative time; Orthopedic trauma patient; Resident; Risk factor