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Fellow Versus Resident

Graduate Medical Education and Patient Outcomes After Anterior Cervical Diskectomy and Fusion Surgery

Galetta, Matthew S. BA; Fang, Taolin MD; Goyal, Dhruv K.C. BA; Divi, Srikanth N. MD; Schroeder, Gregory D. MD; Kepler, Christopher K. MD, MBA; Vaccaro, Alexander R. MD, PhD, MBA

Journal of the American Academy of Orthopaedic Surgeons: July 30, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-18-00645
Research Article: PDF Only

Introduction: The effect of spine fellow versus orthopaedic surgery resident assistance on outcomes in anterior cervical diskectomy and fusion (ACDF) has not been well studied. The objective of this study was to determine differences in patient health-related outcomes based on the level of surgical trainees.

Methods: Consecutive cases of ACDF (n = 407) were reviewed at a single high-volume institution between 2015 and 2017 and were separated into two groups based on whether they were fellow-assisted or resident-assisted. Demographic and clinical variables were recorded, and health-related quality of life was evaluated using the Short Form-12 (SF-12) survey. The SF-12, visual analog scale pain score, and neck disability index were compared between the two groups. Surgery level, surgical time, preoperative Charlson Comorbidity Index, estimated blood loss, equivalent morphine use, perioperative complications, and 30-day readmission were also recorded. Patient outcomes were compared using an unpaired t-test as well as multivariate linear regression, controlling for age, sex, body mass index, Charlson Comorbidity Index, presurgical visual analog scale, SF-12, and neck disability index. Results were reported with the 95% confidence interval.

Results: Spine surgery fellows and orthopaedic surgery residents participated in 228 and 179 ACDF cases, respectively. No notable demographic differences between the two groups were found. A higher proportion of three or more level ACDF surgeries assisted by fellows versus residents was found. Estimated blood loss was greater in fellow-assisted ACDF cases. Both surgery time and total time in the room were also longer in the fellow-assisted ACDF group. No 30-day readmissions were found in either groups, and only one case of acute hemorrhagic anemia was found in the fellow-assisted group. Overall, postoperative complications were higher in the resident group; however, no difference with regard to intraoperative complications between groups was found.

Discussion: This study shows that patient health-related outcomes are similar in ACDF cases that were fellow-assisted versus resident-assisted. However, fellow-assisted ACDF cases were associated with more blood loss and longer surgery time.

From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.

Correspondence to Dr. Vaccaro:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Galetta, Dr. Fang, Mr. Goyal, Dr. Divi, Dr. Schroeder, Dr. Kepler, and Dr. Vaccaro.

© 2019 by American Academy of Orthopaedic Surgeons
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