Resident Participation is Not Associated With Worse Outcomes After TKA

Bao, Mike H.; Keeney, Benjamin J.; Moschetti, Wayne E.; Paddock, Nicholas G.; Jevsevar, David S.

doi:10.1007/s11999.0000000000000002

Cited by 26 publications

(32 citation statements)

References 40 publications

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“…Length of surgery was not associated with implant selection. Instead, individual attending surgeons were associated with greater variations in operative duration (Appendix 1), as shown in Bao et al [20]. Women and older patients were associated with shorter length of surgery, possibly due to decreased muscle mass and increased ease of the procedure.…”

Section: Discussionmentioning

confidence: 91%

“…The repeated measures of PROMs were captured at 6 periods relative to the surgery for the purposes of this report. These were defined as an early PROM well before surgery (46+ days before surgery), baseline preoperative (1-45 days before surgery), 1-month postoperative (1-46 days after surgery), 3-months postoperative (46-299 days), 1-year postoperative (300-420 days), and greater than one year (421+ days) [18,20], Table 1 displays the capture counts per time period. Because the PCS and PCS MCID models require both pre-and postoperative PCS, those models include 1791 surgeries (85%) (Table 1).…”

Section: Variablesmentioning

confidence: 99%

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Short term patient outcomes after total knee arthroplasty: Does the implant matter?

et al. 2019

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Background-Newer implants for total knee arthroplasty (TKA) often gain market share at higher cost with little patient-reported and long-term clinical data. We compared outcomes after TKA using two different implants: Depuy PFC Sigma and Attune.Methods-Using a prospective data repository from an academic tertiary medical center, we analyzed 2116 TKAs (1603 Sigma and 513 Attune) from April 2011 through July 2016. Outcomes included length of surgery, length of stay, facility discharge, 90-day reoperation, range of motion (ROM) change, and patient-reported physical function (PCS).Results-There was no difference in length of surgery (Attune −2.87 minutes, P=0.143). Implant type was not associated with extended LOS (>3 days) (OR 0.80, P=0.439). There was no difference in facility discharge (OR 0.65, P=0.103). Unadjusted 90-day reoperations were 0.3% for *

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Section: Discussionmentioning

confidence: 91%

Section: Variablesmentioning

confidence: 99%

Short term patient outcomes after total knee arthroplasty: Does the implant matter?

et al. 2019

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“…Furthermore, they found that whether a consultant or trainee had performed the procedure had no significant effect on outcomes. Other similar studies have reported that outcomes may be comparable between trainees and supervisors when operations are performed under supervision or using a navigation system [19][20][21][22]. The major difference in our study was that we compared the outcomes of more and less experienced surgeons in the same patients without the use of a navigation system.…”

Section: Discussionmentioning

confidence: 93%

Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

Goto

Katsuragawa

Miyamoto

2020

Knee Surg & Relat Res

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Purpose: There are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes. Materials and methods: Nineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip-knee-ankle angle, and femoral and tibial component angle were evaluated. Results: The mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2°in group S and 114.2°in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip-knee-ankle angle, femoral component angle, or tibial component angle were observed. Conclusions: Although operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed. Level of evidence: IV (retrospective case series design).

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“…Moving forward, it would be interesting to see if the results of this trial would be different depending on the level of the primary operator. One could anticipate greater differences in operating times and other surgical outcomes if gynaecology trainees were the primary operators, 22,23 as trainees may not be as proficient and coordinated in using Gyrus PKS™ with the monopolar scissors vs the all‐in‐one LigaSure™. This could potentially have a significant impact on resource allocations in training institutes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of surgical outcomes using Gyrus PKS™ vs LigaSure™ in total laparoscopic hysterectomy: A randomised controlled trial

Wong

Goh

Merkur

2020

Aust NZ J Obst Gynaeco

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Background Advanced vessel sealing devices are widely used in laparoscopic surgery. However, there remains a lack of adequately powered trials comparing laparoscopic advanced vessel sealing devices in the clinical setting, especially in gynaecology. Aims This single‐blinded randomised controlled trial aims to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) using either the Gyrus PKS™ LYONS dissecting forceps or the LigaSure™ Maryland jaw vessel sealer/divider. Materials and Methods Women who required TLHs for benign indications were randomised to having their surgeries performed using either Gyrus PKS™ or LigaSure™. Time to haemostasis (from initial skin incision to detachment of the uterus with secured haemostasis) was the primary outcome; a 20% difference in time was considered clinically significant. Secondary outcomes measured were intra‐operative blood loss, complications, conversions, post‐operative analgesia use, and length of stay. This study was registered with the Australia New Zealand Clinical Trials Registry ACTRN12615000639516. Results Sixty‐four women were included in the study – 33 and 31 in the Gyrus PKS™ and LigaSure™ arms, respectively. TLHs performed by LigaSure™ had statistically significantly shorter time to haemostasis compared to Gyrus PKS™ by 10.6 min (95% CI 1.3–2.0, P = 0.03). There were no differences in any of the other secondary outcomes measured. Conclusions This trial suggests there is no difference between using either device. TLHs performed using LigaSure™ have statistically significantly shorter time to haemostasis than those using Gyrus PKS™; however, the difference is not considered clinically significant as it was only 14.2%. No other differences in surgical outcomes were detected.

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Resident Participation is Not Associated With Worse Outcomes After TKA

Cited by 26 publications

References 40 publications

Short term patient outcomes after total knee arthroplasty: Does the implant matter?

Short term patient outcomes after total knee arthroplasty: Does the implant matter?

Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

Comparison of surgical outcomes using Gyrus PKS™ vs LigaSure™ in total laparoscopic hysterectomy: A randomised controlled trial

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