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Resident Involvement and Plastic Surgery Outcomes: An Analysis of 10,356 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

Jordan, Sumanas W. M.D.; Mioton, Lauren M. B.S.; Smetona, John B.A., B.S.; Aggarwal, Apas; Wang, Edward Ph.D.; Dumanian, Gregory A. M.D.; Kim, John Y. S. M.D.

Plastic and Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 763–773
doi: 10.1097/PRS.0b013e3182818bdd
Reconstructive: Trunk: Outcomes Article
Discussion

Background: Intraoperative experience is an essential component of surgical training. The impact of resident involvement in plastic surgery has not previously been studied on a large scale.

Methods: The authors retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2010 for all reconstructive plastic surgery cases. Resident involvement was tracked as an individual variable to compare outcomes.

Results: A total of 10,356 cases were identified, with 43 percent noted as having resident involvement. The average total relative value units, a proxy for surgical complexity, and operative time were higher for procedures with residents present. When balanced by baseline characteristics using propensity score stratification into quintiles, no differences in graft, prosthesis, or flap failure or mortality were observed. Furthermore, there were no differences in overall complications or wound infection with resident involvement for a majority of the quintiles. Multivariable logistic regression analysis revealed that resident involvement was a significant predictor of overall morbidity, but not associated with increased odds of wound infection, graft, prosthesis or flap failure, or overall mortality.

Conclusions: Residency has the dual mission of training future physicians and also providing critical support for academic medical centers. Using a large-scale, multicenter database, the authors were able to confirm that well-matched cohorts with—and without—resident presence had similar complication profiles. Moreover, even when residents were involved in comparably more complex cases with longer operative times, infection, graft and flap failure, and mortality remained similar.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Chicago and Evanston, Ill.; and Nashville, Tenn.

From the Division of Plastic and Reconstructive Surgery, the Department of Surgery, and the Biostatistics Core, Northwestern University, Feinberg School of Medicine, and Vanderbilt University School of Medicine.

Received for publication September 27, 2012; accepted October 18, 2012.

Disclaimer: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No external funds were received.

John Y. S. Kim, M.D.; Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, jokim@nmh.org

©2013American Society of Plastic Surgeons