397 - Impact of Resident Involvement on Complications Following Lumbar Decom...

#397 Impact of Resident Involvement on Complications Following Lumbar Decompression Surgery

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Although fundamental to the practice of medicine, the need to train the next generation of surgeons may compromise the quality of care delivered to patients. The goal of this study was to characterize the impact of resident involvement on the rates of complications following lumbar decompressive (LD) surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was searched to identify patients undergoing a LD for degenerative diagnoses between 2006 and 2011. Patients were divided into two cohorts based upon resident participation during the surgical procedure. Preoperative health and comorbidity data including laboratory values, as well as operative time, blood transfusions, 30-day outcomes, length of stay (LOS), readmission/reoperation rates, and individual complication rates were compared between groups. Statistical analysis was performed with SPSS v.20 utilizing independent T-tests and χ2-tests for continuous and categorical variables, respectively. p-values ≤0.05 were considered statistically significant.

Results: A total of 11,055 LDs were identified between 2006 and 2011, including 3,339 (30%) cases with resident involvement. The cases with resident involvement demonstrated a lower rate of females, a lower BMI and a higher incidence of alcohol abuse than those cases without resident involvement (p< 0.05). There was a higher rate of clean-contaminated and contaminated surgical wounds in those cases with resident involvement (p< 0.05). Furthermore, the operative time and hospital length of stay were longer in the resident involved cohort (p < 0.05). The rates of reoperation, deep wound infections, pulmonary embolisms (PE), peripheral nerve injuries, blood transfusions, deep vein thrombosis (DVT) and sepsis were higher in those patients with resident involvement. There were no differences in mortality between the two cohorts.

Conclusions: Thirty-day postoperative complication data indicated higher rates of reoperations, deep wound infections, PEs, blood transfusions, DVTs and sepsis in those cases with resident involvement. Differences in preoperative wound class and a longer operative time may help explain the increased rates of postoperative complications. Despite these findings, there were no differences in the hospital LOS and mortality between the two cohorts. In light of these findings, further analysis is warranted in order to determine preoperative measures that should be undertaken to help mitigate the peri-operative complications associated with resident involvement during a LD procedure.

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