The Impact of Resident Participation in Outpatient Plastic Surgical Procedures

Massenburg, Benjamin B.; Sanati-Mehrizy, Paymon; Jablonka, Eric M.; Taub, Peter J.

doi:10.1007/s00266-016-0651-8

Cited by 18 publications

(5 citation statements)

References 29 publications

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“…Those studies have found that there was no difference in overall outcomes in surgical cases performed with or without the use of residents. 9,[28][29][30][31][32][33][34][35] Thus far, the data support comparable outcomes and efficiency between cases which do not involve trainees and cases involving trainees. 26,35 The operating room is one of the costliest aspects of health care; therefore, maximizing utilization through overlapping or simultaneous operations allows for improvements in the delivery of cost-effective and timely care.…”

Section: Discussionmentioning

confidence: 63%

“…To determine if resident involvement affected complication rates, there have been several investigations on the impact of resident involvement in surgical operations. Those studies have found that there was no difference in overall outcomes in surgical cases performed with or without the use of residents 9,28–35 . Thus far, the data support comparable outcomes and efficiency between cases which do not involve trainees and cases involving trainees 26,35 …”

Section: Discussionmentioning

confidence: 90%

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Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck

Sweeny

Rosenthal

Light

et al. 2017

Otolaryngol.--head neck surg.

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Objective To compare outcomes after microvascular reconstructions of head and neck defects between overlapping and nonoverlapping operations. Study Design Retrospective cohort study. Setting Tertiary care center. Subjects and Methods Patients undergoing microvascular free tissue transfer operations between January 2010 and February 2015 at 2 tertiary care institutions were included (n = 1315). Patients were divided into 2 cohorts by whether the senior authors performed a single or consecutive microvascular reconstruction (nonoverlapping; n = 773, 59%) vs performing overlapping microvascular reconstructions (overlapping; n = 542, 41%). Variables reviewed were as follows: defect location, indication, T classification, surgical details, duration of the operation and hospitalization, and complications (major, minor, medical). Results Microvascular free tissue transfers performed included radial forearm (49%, n = 639), osteocutaneous radial forearm (14%, n = 182), anterior lateral thigh (12%, n = 153), fibula (10%, n = 135), rectus abdominis (7%, n = 92), latissimus dorsi (6%, n = 78), and scapula (<1%, n = 4). The mean duration of the overlapping operations was 21 minutes longer than nonoverlapping operations ( P = .003). Mean duration of hospitalization was similar for nonoverlapping (9.5 days) and overlapping (9.1 days) cohorts ( P = .39). There was no difference in complication rates when stratified by overlapping (45%, n = 241) and nonoverlapping (45%, n = 344) ( P = .99). Subset analysis yielded similar results when minor, major, and medical complications between groups were assessed. The overall survival rate of free tissue transfers was 96%, and this was same for overlapping (96%) and nonoverlapping (96%) operations ( P = .71). Conclusions Patients had similar complication rates and durations of hospitalization for overlapping and nonoverlapping operations.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 90%

Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck

Sweeny

Rosenthal

Light

et al. 2017

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7][8][9][10] Given these considerations, it remains paramount to understand the perspective of attending surgeons who must balance commitments to teach residents in surgical cases while optimizing clinical productivity to maintain revenue. [11][12][13][14] Up to date, studies on complications and re-admissions associated with resident involvement have not established a clear pattern. [1][2][3][4][5][6][7][8][9][10] Furthermore, the increasing pressures to maximize clinical productivity, paired with the shift towards bundled payment models and value-based care, may dis-incentivize resident involvement in the operating room thus weakening the mission of academic medicine.…”

mentioning

confidence: 99%

“…For several surgical specialties, data has shown an increase in operative time, length of stay, and overall cost associated with resident participation in such cases 1–10 . Given these considerations, it remains paramount to understand the perspective of attending surgeons who must balance commitments to teach residents in surgical cases while optimizing clinical productivity to maintain revenue 11–14 . Up to date, studies on complications and re-admissions associated with resident involvement have not established a clear pattern 1–10 .…”

mentioning

confidence: 99%

The Opportunity Cost of Resident Involvement in Adult Craniofacial Surgery: An Analysis of Relative Value Units

Khetpal

Phillips

Parsaei

et al. 2021

Journal of Craniofacial Surgery

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Purpose: Within the academic surgical setting resident involvement may confer longer operative times. The increasing pressures to maximize clinical productivity and decreasing reimbursement rates, however, may conflict with these principles. This study calculates the opportunity cost of resident involvement in craniofacial surgery. Methods: Retrospective analysis was conducted with patients who underwent craniofacial procedures from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Patients were selected based on relevant Current Procedural Terminology codes for craniofacial pathologies (ie, trauma, head and neck reconstruction, orthognathic surgery, and facial reanimation). Variables included patient demographics, operative time, and presence or absence of resident trainee. Average relative value units were calculated to determine the opportunity cost of resident involvement for each craniofacial procedure. Results: In total, 2096 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Resident involvement was associated with a statistically significant higher operative time (P < 0.001) for facial reanimation, facial trauma, orthognathic surgery, and head and neck reconstruction. The opportunity costs per case associated with resident involvement were the highest for head and neck reconstruction ($1468.04), followed by orthognathic surgery ($1247.03), facial trauma ($533.03), and facial reanimation ($358.32). Resident involvement was associated with higher rate of complications for head and neck reconstruction (P < 0.043). Conclusions: Resident involvement is associated with longer operative times, higher complications, and higher re-operations, compared to attending exclusive surgical care. Future studies may consider how reimbursements should align incentives to promote resident education and training.

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“…A few studies, however, showed increased overall morbidity rate in various general surgery procedures [9,14]. Interestingly, several of the studies showed that trainee participation did not negatively impact morbidity or mortality and deemed that resident participation is overall safe for surgical patients [14][15][16].…”

mentioning

confidence: 99%

Surgical trainee impact on bariatric surgery safety

et al. 2018

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Background Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) are commonly performed bariatric procedures that are associated with a significant learning curve. The effect of surgeon experience on perioperative outcomes and safety is established, but the effect of trainee participation remains unclear. The purpose of this study was to assess the impact of trainees on early perioperative safety of bariatric surgery. Methods Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for 2015 was used to identify non-revisional laparoscopic and robotic RYGB and SG procedures. Comparisons were made based on assistant level. Multivariable logistic and linear regression methodology was used to compare clinical outcomes. Results There were 35,354 laparoscopic RYGB, 2896 robotic RYGB, 79,717 laparoscopic SG, and 5449 robotic SG procedures examined. 21,257 (17%) and 11,322 (9%) of all procedures were performed with a resident or fellow, respectively. Fellow presence was independently associated with the development of complications for all procedure types except robotic SG when compared to non-trainee [odds ratio (OR) 1.31, 2.20, 1.28 for laparoscopic RYGB, robotic RYGB, and laparoscopic SG, respectively]. The most common events were urinary tract and superficial surgical site infections. This negative impact of fellow on overall complications was eliminated after accounting for operative duration. In laparoscopic SG, resident participation was associated with higher leak rate (OR 1.61), readmission (OR 1.18), re-intervention (OR 1.4), and complication rate (OR 1.32) compared to non-trainee, even after accounting for procedural duration. In robotic SG, there was no impact of trainee on outcomes. Conclusions Although fellow training is associated with higher overall complication rate, there is no such impact on major safety benchmarks, including leak rate and re-operation. In contrast, the impact of resident trainees on SG outcomes is substantial. Operative involvement of trainees in bariatric surgery leads to different outcomes based on trainee level and should be judiciously considered during the programmatic design of bariatric educational curricula.

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The Impact of Resident Participation in Outpatient Plastic Surgical Procedures

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 18 publications

References 29 publications

Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck

Effect of Overlapping Operations on Outcomes in Microvascular Reconstructions of the Head and Neck

The Opportunity Cost of Resident Involvement in Adult Craniofacial Surgery: An Analysis of Relative Value Units

Surgical trainee impact on bariatric surgery safety

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