PRS AAPS Oral Proofs 2016
Mohamad E. Sebai, MBBS, Ricardo J. Bello, MD, MPH, Scott D. Lifchez, MD, Damon S. Cooney, MD, PhD, Gedge D. Rosson, MD, Carisa M. Cooney, MPH
From the Johns Hopkins Hospital, Baltimore, Md.
PURPOSE: The aim of this study was to assess whether resident involvement (RI) in immediate breast reconstruction (IBR) is associated with increased 30-day surgical morbidity.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients undergoing IBR between 2005 and 2012. Preoperative demographics, intraoperative variables, RI in surgery, and 30-day postoperative surgical morbidities were identified. Chi-square test and multivariable logistic regression were used to estimate the effect of RI on surgical complications.
RESULTS: Twenty-four thousand five patients underwent IBR (17,840 with RI). Thirty-day surgical morbidity was observed in 5.25% [95% confidence interval (CI), 4.92%–5.58%] of cases with RI and 5.12% (95% CI, 4.59%–5.58%) of cases without RI. Odds of surgical complications were not statistically different between groups [unadjusted odds ratio (OR), 1.03; 95% CI, 0.90–1.17, P = 0.690] even after controlling for confounding with multivariable logistic regression (adjusted OR, 0.97; 95% CI, 0.85–1.11; P = 0.652). Subgroup analysis by type of reconstruction showed that RI was not associated with surgical complications in implant-based reconstructions but was associated with lower odds of surgical complications in autologous reconstructions (OR, 0.70; 95% CI, 0.53–0.91; P = 0.008). However, operative time and reoperation rates were significantly higher with RI across all types of reconstruction (both P < 0.001). Postoperative length of stay was statistically significantly longer with RI in autologous reconstruction (mean = 3.94, SD = 2.42 vs mean = 3.73, SD = 1.78, respectively; P = 0.015) but not in implant reconstruction (P = 0.765).
CONCLUSIONS: Although this study found no statistically significant evidence for increased postoperative surgical morbidity in IBR patients for whom residents were involved, RI statistically significantly increased operative time, postoperative length of stay, and reoperation rates.