426 - Impact of Resident Involvement on Complications Following Lumbar Fusio...

#426 Impact of Resident Involvement on Complications Following Lumbar Fusion Surgery

Lumbar Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

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

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

Abstract

Introduction: Fundamental to the practice of medicine is the commitment to provide high quality care to patients, maximizing positive outcomes and minimizing complications. Equally important, though at times seemingly contrary to that central tenet, is the need to train the next generation of medical practitioners. The goal of this study is to characterize the impact of trainee involvement on the rates of complications following lumbar spine fusion (LF) surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was searched to identify patients undergoing LF for degenerative diagnoses between 2006 and 2011. Patients with non-elective and non-degenerative diagnoses were excluded from the analysis. Patients were divided into two cohorts based upon resident participation during the surgical procedure. Pre-operative health and co-morbidity data including laboratory values, operative time, blood transfusions, 30-day outcomes, length of stay (LOS), re-admission/re-operation rate, and individual complication rates were compared between groups. Statistical analysis was performed with SPSS v.20 using independent t-tests and χ2-tests for continuous and categorical variables, respectively. P-values ≤0.05 were considered statistically significant.

Results: A total of 5,680 LFs were identified between 2006 and 2011, including 1,917 (33.7%) with resident involvement. The two groups were statistically similar with regards to demographic, preoperative health and co-morbidity, and preoperative laboratory data with the exception of older patients (59.8 vs. 58.0 years; p < 0.0001), a lower rate of diabetes (14.9 vs. 17.3%; p = 0.02), smoking (21.8 vs. 25.5%; p = 0.002), and pre-operative paralysis (4.0 vs 7.5%; p < 0.0001), as well as lower serum albumin (4.09 vs 4.15; p = 0.002) in those cases with resident involvement. There was a higher rate of ASA class 3 patients in the resident cohort (p = 0.01). Operative time (234.0 vs. 197.7 minutes; p < 0.0001), length of stay, (4.26 vs 3.77 days; p < 0.0001), and the number of transfusions were greater (0.525 vs 0.282; p < 0.0001) in those cases with resident involvement. Overall complications were increased with resident involvement (1.98 vs 1.14%; p = 0.01), with superficial wound infection (1.98 vs 1.14%; p = 0.01), blood transfusion (15.9 vs 10.9%; p < 0.0001), DVT (1.25 vs 0.72%; p = 0.04), and sepsis (2.35 vs 0.48%; p < 0.0001) demonstrating significant differences.

Conclusion: This study utilizes the NSQIP database to examine the effect of resident involvement on complication rates following lumbar fusion surgery. While there were slight differences in the two groups with respect to age and race, these variables were not substantially different. Those cases without resident involvement may have been healthier given the decreased rates of diabetes, smoking, and paralysis. Several differences in outcome were noted between the groups, notably an increased length of stay, overall complication rates, superficial infections, rates of blood transfusions, deep vein thromboses, and sepsis in those cases with resident involvement. A significant limitation of the study is the inability to identify the extent of resident involvement during the surgical procedure. As such, further analysis is needed before definitive conclusions can be made regarding surgical outcomes associated with resident involvement.