The Impact of Resident Involvement on Postoperative Complications After Shoulder Arthroscopy: A Propensity-Matched Analysis

Abstract

Purpose: Shoulder arthroscopy is the second most frequently performed procedure by orthopaedic surgeons taking the American Board of Orthopaedic Surgery part II examination. However, the impact of resident involvement on outcomes after shoulder arthroscopy is poorly understood. The aim of this study was to investigate whether resident involvement in shoulder arthroscopic procedures affects postoperative complication rates and surgical time using propensity score-matched cohorts. Methods: The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent common shoulder arthroscopic procedures between 2006 and 2012. Cases without information on resident involvement, treatment of septic arthritis or osteomyelitis of the shoulder, or concomitant open or miniopen procedures were excluded from the study. A 1:1 propensity score match was used based on demographic and comorbidity factors to match cases with resident involvement to nonresident cases. Patient demographics, comorbidities, surgical time, length of hospital stay, and 30-day postoperative complications were compared between the two groups. Results: Overall, 15,857 patients who underwent shoulder arthroscopy were identified. After propensity score matching, 3474 cases (50% with resident involvement) were included. Appropriate matching was verified with no difference in demographic or health characteristics. No significant differences in the overall rate of 30-day complications was noted in resident-involved versus nonresident group ( P = 0.576). No significant difference was observed in postoperative surgical or medical complications. Resident involvement was significantly longer surgical time (75.9 ± 35.9 versus 75.1 ± 40.5 minutes, P = 0.03) when compared with cases performed without a resident. Conclusions: Resident involvement in shoulder arthroscopy is not associated with increased risk for medical or surgical 30-day postoperative complications. Resident participation in shoulder arthroscopy cases did increase surgical time; however, this finding is likely clinically insignificant.

Impact of Resident Involvement on 30-Day Postoperative Outcomes in Orthopedic Shoulder Surgery

“…This agrees with previous studies across various divisions of orthopedic surgery, including shoulder, knee, hip, spine, and trauma [ 3 – 6 , 10 – 33 ]. Additionally, this study agrees with the well-documented conclusion that resident presence increases operation time [ 3 , 4 , 13 , 15 – 17 , 21 , 22 , 25 , 29 , 31 , 33 , 35 ].…”

“…Interestingly, and in disagreement with other studies and the present study, Basques et al found no increase in operation time with resident participation [ 18 ]. Also, examining shoulder arthroscopy, Gulbrandsen et al used a propensity-matched analysis to demonstrate that there was no difference in the overall rate of 30-day complications in the resident versus nonresident group ( P =0.576) [ 13 ]. Jovan et al illustrated no significant increase in 30-day postoperative outcomes when examining resident involvement in shoulder stabilization surgery [ 35 ].…”

“…While previous studies have documented the outcomes of resident involvement in hip [ 11 , 15 , 22 ], knee [ 12 , 27 , 30 ], spine [ 10 , 21 ], and trauma surgery [ 34 ], few have looked at the outcomes of shoulder surgery with resident involvement. Of these studies, only bicep tenodesis [ 20 ], shoulder stabilization [ 35 ], shoulder arthroscopy [ 3 , 13 , 18 ], and total shoulder arthroplasty (TSA) [ 19 , 36 ] have been examined. In reviewing the available orthopedic literature, no study has investigated the impact of resident involvement across all types of shoulder surgeries.…”

Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases

“… 3 , 9 The number of studies that did not demonstrate the existence of the effect is still growing, mainly in research on groups of medical specialties. 10 , 11 , 12 , 13 Therefore, the existence and size of this effect still need to be studied, as well as its implications for medical training and patient care in university hospitals.…”

Clinical efficacy of intra-articular infusion of cocktail combined with tranexamic acid in the treatment of middle-age and older patients with frozen shoulder following arthroscopic capsular release

“…Traditional open surgery has largely been abandoned. Arthroscopic capsular release has the advantages of less trauma, fast postoperative recovery, less pain, and good shoulder joint function recovery (4)(5)(6), which is gradually more commonly applied clinically. However, during shoulder arthroscopy, extensive and complete capsular release is required in order to achieve good results, so tissue damage, pain, edema and bleeding are unavoidable.…”