396 - Resident Involvement and the Potential Impact on Complications Followi...

#396 Resident Involvement and the Potential Impact on Complications Following Single-level 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: 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 our study is to characterize the impact of resident involvement on the rates of complications following a single-level lumbar decompression (LD).

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was searched to identify patients undergoing single-level 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 8,889 single-level LDs were identified between 2006 and 2011, including 2,520 (39.5%) cases with resident involvement. The cases with resident involvement demonstrated a lower rate of females, younger age, lower rate of cardiac disease, lower rate of hypertension and a lower rate of peripheral vascular disease than in 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). Operative time was longer (116.5 vs. 103.3 minutes; p < 0.05), and the rates of postoperative peripheral nerve injury (0.24 vs 0.03%; p< 0.05) and sepsis (0.75 vs 0.41%; p< 0.05) were increased in those cases with resident involvement. There were no differences in mortality between the two cohorts.

Conclusions: Thirty-day postoperative complication data indicated a higher rate of peripheral nerve injury and sepsis in those cases involving residents. Infectious complications may be attributable to the longer operative times and the increased incidence of clean-contaminated and contaminated wounds found in the resident involvement cohort. Despite these findings, there were no differences in the hospital LOS and mortality between the two cohorts. Further studies are warranted to better characterize the association between perioperative outcomes and the amount and type of resident involvement during a single-level LD procedure.

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