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Cintean R, Degenhart C, Pankratz C, Gebhard F, Schütze K. An Analysis of 1000 Patients With the "Big 5" Orthopaedic Surgery Procedures and the Impact of Residents on Outcome. JOURNAL OF SURGICAL EDUCATION 2024; 81:1683-1690. [PMID: 39293193 DOI: 10.1016/j.jsurg.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND The study is intended to show that the operative quality of a resident in orthopedic trauma surgery is comparable to that of a senior physician in the most common orthopaedic trauma surgeries (Plate osteosynthesis in ankle fractures and distal radius fractures, ESIN in pediatric forearm fractures, implantation of a proximal femoral nail in pertrochanteric femur fractures and hemiarthroplasty in femoral neck fractures) with appropriate supervision by a senior physician. With only minimal deviations in the operating time, which is becoming increasingly relevant in everyday clinical practice, surgical training of residents could be supported. MATERIAL AND METHODS 200 patients of the above-mentioned fracture patterns each, who were treated surgically between January 1, 2016 and December 31, 2020, were detected and categorized. In particular, a qualitative characteristic was determined for each fracture on the basis of the standard pre and postoperative X-rays taken during surgery and statistically evaluated with the surgery time, the fracture classification and the training status of the anonymized surgeon. Anonymized x-rays were evaluated by 2 senior physicians and 2 residents. RESULTS Operations were performed by residents in 33.5 % of the cases (ankle fractures 42.0%; distal radius fractures 30.5%; pediatric forearm fractures 30.5%; pertrochanteric femur fractures 50.5%; femoral neck fractures 14.0%). Surgical complication rate was 4.8% in the resident group and 9.0% in the attending surgeon group. Revision surgeries were performed in 2.1% of resident cases, and in 4.1% of attending surgeon cases. In the resident group, time of surgery was 7.4 min longer for ankle fractures, 4.4 min for distal radius fractures, 2.8 min for forearm fractures, 2.3 min longer in proximal femur fractures 8.2 min longer for femoral neck fractures. No statistically significant difference in radiological outcome was observed in any of the groups after evaluation of the x-rays. CONCLUSION This study shows that only slightly more than one third of all mentioned operations are performed by residents, although there is no statistical difference in quality. The operating time is extended on average by only 5 minutes. The surgical complication rate as well as the revision rate is higher in the group of senior physicians, whereby the more complicated fractures were treated by them. Resident involvement in trauma surgery is therefore not associated with increased morbidity or mortality of patients.
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Affiliation(s)
- Raffael Cintean
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany.
| | - Christina Degenhart
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany
| | - Carlos Pankratz
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany
| | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany
| | - Konrad Schütze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Ulm, Germany
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Marder RS, Shah NV, Naziri Q, Maheshwari AV. The impact of surgical trainee involvement in total knee arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:255-298. [PMID: 35022881 DOI: 10.1007/s00590-021-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. RESULTS Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. CONCLUSION Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion.
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Affiliation(s)
- Ryan S Marder
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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Alexander B, Sowers M, Jacob R, McGwin G, Maffulli N, Naranje S. The Impact of Resident Involvement on Patient Outcomes in Revision Total Hip Arthroplasty. Rev Bras Ortop 2023; 58:133-140. [PMID: 36969789 PMCID: PMC10038725 DOI: 10.1055/s-0041-1736469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022] Open
Abstract
Objective The aim of the present study was to determine the influence of resident involvement on acute complication rates in revision total hip arthroplasty (THA). Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 1,743 revision THAs were identified from 2008 to 2012; 949 of them involved a resident physician. Demographic information including gender and race, comorbidities including lung disease, heart disease and diabetes, operative time, length of stay, and acute postoperative complications within 30 days were analyzed. Results Resident involvement was not associated with a significant increase in the risk of acute complications. Total operative time demonstrated a statistically significant association with the involvement of a resident (161.35 minutes with resident present, 135.07 minutes without resident; p < 0.001). There was no evidence that resident involvement was associated with a longer hospital stay (5.61 days with resident present, 5.22 days without resident; p = 0.46). Conclusion Involvement of an orthopedic resident during revision THA does not appear to increase short-term postoperative complication rates, despite a significant increase in operative times.
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Affiliation(s)
- Bradley Alexander
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
| | - Mackenzie Sowers
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
| | - Roshan Jacob
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
| | - Gerald McGwin
- Departamento de Epidemiologia, Universidade do Alabama em Birmingham, Universidade Boulevard Birmingham, Alabama, Estados Unidos
| | - Nicola Maffulli
- Departamento de Distúrbios Musculoesqueléticos, Faculdade de Medicina e Cirurgia, Universidade de Salerno, Baronissi, Itália
| | - Sameer Naranje
- Divisão de Cirurgia Ortopédica, Universidade do Alabama em Birmingham, Birmingham, Alabama, Estados Unidos
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Anis HK, Rothfusz CA, Eskildsen SM, Klika AK, Piuzzi NS, Higuera CA, Molloy RM. Does Surgical Trainee Participation Affect Infection Outcomes in Primary Total Knee Arthroplasty? JOURNAL OF SURGICAL EDUCATION 2022; 79:993-999. [PMID: 35300952 DOI: 10.1016/j.jsurg.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/10/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA). DESIGN This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume. SETTING A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017. PARTICIPANTS A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated. RESULTS Residents and fellows were more likely to participate in cases with longer operative times (p<0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998). CONCLUSIONS Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.
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Affiliation(s)
- Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Christopher A Rothfusz
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | | | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio.
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation Florida, Weston Hospital, Weston, Florida
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio
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Maheshwari AV, Garnett CT, Cheng TH, Buksbaum JR, Singh V, Shah NV. Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty. Arthroplast Today 2022; 15:202-209.e4. [PMID: 35774880 PMCID: PMC9237261 DOI: 10.1016/j.artd.2022.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/08/2022] [Accepted: 02/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs). Material and methods Fifty patients undergoing single-staged sequential bilateral primary TKAs were evaluated. The more symptomatic side was performed by the attending surgeon first, followed by the contralateral side performed by a chief resident under direct supervision and assistance of the same attending surgeon. Surgery was subdivided into 8 critical steps on both sides. The overall time and critical stepwise surgical time and short-term clinical outcomes were then compared between the 2 sides. Results The attending surgeon completed the surgery (skin incision to dressing) significantly faster than the resident (70.2 vs 96.9 minutes) by a mean of 26.7 minutes (P < .05) and was also faster in all steps. The most significant differences in time were in “exposure” (9.5 vs 16.5 minutes) and “closure” steps (13.2 vs 24.9 minites), all P < .001. Adverse events occurred in 7 patients; 5 of these resolved uneventfully. There were no significant differences in surgical complications, objective outcome scores, or patient satisfaction scores between both sides. Conclusion Resident participation in TKA increased operative time without jeopardizing short-term patient clinical outcomes, satisfaction, and complications. This may alleviate concerns from patients and policymakers about TKA in an academic setting. Surgical “exposure” and “closure” were the most prolonged steps for the residents, and they may benefit with more focus and/or simulation studies during training.
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Crawford DA, Berend KR, Lombardi AV. Fellow Involvement in Primary Total Knee Arthroplasty: Is There an "August Effect?". J Knee Surg 2022; 35:83-90. [PMID: 32559787 DOI: 10.1055/s-0040-1713113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study is to determine if a fellow's involvement, as well as duration of a fellow's training, impacts complications, outcomes, and survivorship in primary total knee arthroplasty (TKA). A retrospective review identified 2,790 consecutive patients (3,530 knees) who underwent primary TKA between 2003 and 2008. A 2-year minimum follow-up was available on 2,785 knees (2,195 patients). Operative data, clinical outcomes, complications, and survivorship were compared between cases with and without a fellow involved as well as comparing cases in the first quarter (Q1) of the academic year to the last three quarters (Q2-4). Mean follow-up was 9.7 years. Fellows were involved in 1,434 (41%) surgeries. Fellow cases had significantly longer tourniquet times (59.5 vs. 49 minutes, p < 0.001) and operative times (82.4 vs. 70.8 minutes, p < 0.001). Overall, there was no difference in clinical, functional, or pain outcomes between attending and fellow cases. Fellow cases during Q1 had significantly worse pain scores (p = 0.009) and clinical scores (p < 0.001). Revision rate, infection rates, and survivorship were not significantly different between fellow and attendings or during Q1 of fellowship compared with attendings. Primary TKA survivorship and complications were not affected by fellow involvement or academic quarter. An "August Effect" may be suggested for clinical and pain outcomes in the first 3 months of fellowship.
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Affiliation(s)
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, Ohio.,Mount Carmel Health System, New Albany, Ohio.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Borsinger TM, Simon AW, Culler SD, Jevsevar DS. Does Hospital Teaching Status Matter? Impact of Hospital Teaching Status on Pattern and Incidence of 90-day Readmissions After Primary Total Hip Arthroplasty. Arthroplast Today 2021; 12:45-50. [PMID: 34761093 PMCID: PMC8567323 DOI: 10.1016/j.artd.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Given financial and clinical implications of readmissions after total hip arthroplasty (THA) and the potential for varied expenditures related to a hospital’s teaching status, this study sought to characterize 90-day hospital readmission patterns and assess likelihood of readmission based on teaching designation of a Medicare beneficiaries’ (MB’s) index THA hospital. Methods Retrospective analysis of 2016-2018 Centers for Medicare and Medicaid Services-linked data identified primary THA hospitalizations and readmissions within 90 days. Hospitals were categorized as teaching or nonteaching (Council of Teaching Hospitals and Health Systems). Chi-squared analysis and Fisher exact test assessed differences between readmission hospitals and the index hospital teaching status. Multivariate logistic regression models estimated risk-adjusted probability of experiencing at least one 90-day readmission. Results Analysis identified 433,959 index THA admissions with an all-cause 90-day readmission rate of 9.12%. Most readmissions were to the same hospital regardless of index THA hospital teaching status (67.5% index teaching; 68.2% index nonteaching). Crossover in hospital teaching status from the index procedure to readmission location was more common for those with index THA at a teaching hospital (18.9%) than for MBs with index THA performed at a nonteaching hospital (6.2%). Controlling for patient characteristics, no significant relationship was found between 90-day readmission and index hospital teaching status (odds ratio 0.98, confidence interval 0.947–1.011). Conclusions Overall, while certain patterns of readmission after the index THA were observed, after controlling for patient characters and comorbidities, there was no significant association between 90-day all-cause readmission and index hospital teaching status.
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Affiliation(s)
- Tracy M Borsinger
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Steven D Culler
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Prosthetic joint infection in culture-negative and alpha-defensin-positive patients versus culture-positive and alpha-defensin-negative patients: a retrospective cohort study of the differences in clinical characteristics and outcomes. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rockov ZA, Etzioni DA, Schwartz AJ. The July Effect for Total Joint Arthroplasty Procedures. Orthopedics 2020; 43:e543-e548. [PMID: 32818288 DOI: 10.3928/01477447-20200812-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023]
Abstract
The "July effect" refers to the assumed increased risk of complications during the months when medical school graduates transition to residency programs. The actual existence of a July effect is controversial. With this study, the authors sought to determine whether evidence exists for the presence of a July effect among total joint arthroplasty (TJA) procedures. The 2013 and 2014 Nationwide Readmission Databases were combined and all index primary and revision arthroplasty procedures were identified, and then patients from December were excluded. Thirty-day readmission rates, time to readmission, and readmission costs were analyzed by index procedure month and index procedure type. A total of 1,193,034 procedures (index primary: n=1,107,657; revision arthroplasty: n=85,377) were identified. Among all procedure types, 46,674 (3.9%) 30-day readmissions were observed. Among all procedures, an index procedure with a discharge in July resulted in the highest monthly readmission rate of the year (4.2%), which was significantly higher than the mean annual readmission rate (P<.0001). This effect was most pronounced for primary total knee arthroplasty (3.9% vs 3.6%, P<.0001). When stratifying results into teaching vs nonteaching hospitals, the highest readmission rate occurred if the index procedure occurred at a nonteaching hospital in July (4.5%, P<.0001). These data provide evidence that a July effect appears to exist for TJA procedures and is most pronounced at nonteaching institutions. Based on published mean readmission costs, the total annualized cost variation attributable to the higher readmission rate for primary TJA procedures in July is approximately $18.6 million. [Orthopedics. 2020;43(6):e543-e548.].
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Perfetti DC, Job AV, Satin AM, Katz AD, Silber JS, Essig DA. Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases? Spine J 2020; 20:1397-1402. [PMID: 32445804 DOI: 10.1016/j.spinee.2020.05.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar laminectomy and discectomy surgeries are among the most common procedures performed in the United States, and often take place at academic teaching hospitals, involving the care of resident physicians. While academic institutions are critical for the maturation of the next generation of attending surgeons, concerns have been raised regarding the quality of resident-involved care. There is conflicting evidence regarding the effects of resident participation in teaching hospitals on spine surgery patient outcomes. As the volume of lumbar laminectomy and discectomy increases, it is imperative to determine how academic status impacts clinical and economic outcomes. PURPOSE The purpose of this study is to determine if lumbar laminectomy and discectomy surgeries for degenerative spine diseases performed at academic teaching centers is associated with more adverse clinical outcomes and increased cost compared to those performed at nonacademic centers. STUDY DESIGN/SETTING This study is a multi-center retrospective cohort study using a New York Statewide database. PATIENT SAMPLE We identified 36,866 patients who met the criteria through the New York Statewide Planning and Research Cooperative System who underwent an elective lumbar laminectomy and/or discectomy in New York State between January 1, 2009 and September 30, 2014. OUTCOME MEASURES The primary functional outcomes of interest included: length of stay, cost of the index admission; 30-day and 90-day readmission; 30-day, 90-day, and 1-year return to the operating room. METHODS International Classification of Diseases, Ninth revision codes were utilized to define patients undergoing a laminectomy and/or discectomy who also had a diagnosis code for a lumbar spine degenerative condition. We excluded patients with a procedural code for lumbar fusion, as well as those with a diagnosis of scoliosis, neoplasm, inflammatory disorder, infection or trauma. Hospital academic status was determined by the Accreditation Council for Graduate Medical Education. Unique encrypted patient identifiers allowed for longitudinal follow-up for readmission and re-operation analyses. We extracted charges billed for each admission and calculated costs through cost-to-charge ratios. Logistic regression models compared teaching and nonteaching hospitals after adjusting for patient demographics and comorbidities. RESULTS Compared to patients at nonteaching hospitals, patients at teaching hospitals were more likely to be younger, male, non-Caucasian, be privately insured and have fewer comorbidities (p<.001). Patients undergoing surgery at teaching hospitals had 10% shorter lengths of stay (2.7 vs. 3.0 days, p<.001), but 21.5% higher costs of admission ($13,693 vs. $11,601 p<.001). Academic institutions had a decreased risk of return to the operating room for revision procedures or irrigation and debridement at 30 days (OR:0.70, 95% confidence interval [CI]: 0.60-0.82, p<.001), 90 days (OR:0.75, 95%CI: 0.66-0.86, p<.001), and 1 year (OR:0.84, 95%CI: 0.77-0.91, p<.001) post index procedure. There was no difference in 30- and 90-day all-cause readmission, or discharge disposition between the two groups. CONCLUSIONS Elective lumbar laminectomy and discectomy for degenerative lumbar conditions at teaching hospitals is associated with higher costs, but decreased length of stay and no difference in readmission rates at 30- and 90-days postoperatively compared to nonteaching hospitals. Teaching hospitals had a decreased risk of return to the operating room at 30 days, 90 days and 1 year postoperatively. Our findings might serve as an impetus for other states or regions to compare outcomes at teaching and nonteaching sites.
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Affiliation(s)
- Dean C Perfetti
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - Alan V Job
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA.
| | - Alexander M Satin
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - Austen D Katz
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - Jeff S Silber
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - David A Essig
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ali MJ. COVID-19 pandemic and lacrimal practice: Multipronged resumption strategies and getting back on our feet. Indian J Ophthalmol 2020; 68:1292-1299. [PMID: 32587153 PMCID: PMC7574051 DOI: 10.4103/ijo.ijo_1753_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of this review was to propose multi-pronged resumption strategies for lacrimal practice in an effort to plan a sustainable recommencement of elective surgeries after we emerge from the peak of COVID-19 pandemic. The strategies for lacrimal practice were classified into 7 subtypes, and each of the blueprints were reassessed based on existing information on resumption strategies of elective surgeries from other specialties in COVID-19 era. The specific needs of lacrimal practice were then added to construct algorithms summarizing the resumption strategies. The basic principle of 'primum non nocere' needs to be followed. The overall proposed plan advocates the transition to a more sustainable health care reality in a world where we would still co-exist with COVID-19. A comprehensive effort involving screening, laboratory testing, appropriate triage, effective personal protection and specific precautionary measures for lacrimal clinics and operating room are needed to be able to safely resume elective surgery when the pandemic peak declines. To predict the timing of the resumption of elective surgeries is quite complex and influenced by several geographic, political and economic factors. It is equally important to remember that COVID-19 crisis is a dynamic situation and constantly evolving, hence the strategies provided are subject to change. Strict adherence to standard COVID-19 guidelines combined with effective testing and personal protection strategies can ensure slow yet smooth and safe return to full lacrimal practice after the COVID-19 pandemic calms down. The local government directives, individual and institutional discretion are advised.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
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Zeegen EN, Yates AJ, Jevsevar DS. After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal? J Arthroplasty 2020; 35:S37-S41. [PMID: 32376171 PMCID: PMC7195118 DOI: 10.1016/j.arth.2020.04.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/01/2023] Open
Abstract
The novel coronavirus, severe acute respiratory coronavirus 2 (SARS-CoV-2), pandemic has delivered a profound and negative impact on the United States. The suspension of elective surgeries including arthroplasty will have a lasting effect on all stakeholders including patients, physicians, and healthcare organizations within the US healthcare system. Resumption of elective hip and knee arthroplasty will need to be carefully focused. The purpose of this work is to address potential strategies, concerns, and regulatory barriers in restarting elective hip and knee arthroplasty in the United States.
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Affiliation(s)
- Erik N Zeegen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Adolph J Yates
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David S Jevsevar
- Department of Orthopaedic Surgery, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Pirruccio K, Mehta S, Sheth NP. The Association Between Newly Accredited Orthopedic Residency Programs and Teaching Hospital Complication Rates in Lower Extremity Total Joint Arthroplasty. JOURNAL OF SURGICAL EDUCATION 2020; 77:690-697. [PMID: 31786199 DOI: 10.1016/j.jsurg.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/01/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The influence of residency programs on teaching hospital outcomes in total joint arthroplasty (TJA) has recently been debated. This study investigates how complication and readmission rates for primary elective total hip (THA) and total knee arthroplasty (TKA) changed before and after new orthopedic surgery residency programs meeting ACGME accreditation requirements were introduced at hospitals. DESIGN We conducted a retrospective cohort study using the CMS Hospital Compare database, which contains hospital-level data on risk-standardized complication and readmission rates (2013-2018) for primary elective THA and TKA in Medicare beneficiaries. Orthopedic surgery residency programs that were newly accredited during this time were identified using ACGME publicly available data. SETTING Eight primary adult teaching hospitals with complication and readmission data in the CMS database available prior to the first full year its affiliated residency program was implemented, and with subsequent program data also available. PARTICIPANTS Six ACGME accredited orthopedic surgery residency programs. RESULTS Even after controlling for annual variation in surrounding hospital rates, the at-risk patient volume, and variation in starting rates for a given hospital in the first available year, multivariate linear regression demonstrated that complication rates for lower extremity TJA in Medicare beneficiaries decreased by 0.20 per year (R2 = 0.78, p = 0.005) after hospitals introduced new orthopedic surgery residency programs meeting ACGME accreditation requirements. There were no significant differences in readmission rates after the addition of newly accredited programs to these same hospitals (R2 = 0.51; p = 0.706). CONCLUSIONS Starting an orthopedic surgery residency program meeting ACGME accreditation requirements was associated with significantly reduced complication rates for primary elective lower extremity TJA in Medicare beneficiaries at teaching hospitals where these programs began rotating residents. These findings raise awareness regarding the potential for residency programs to contribute to improved patient care outside of the operating room as well as through direct resident involvement in procedures.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Samir Mehta
- Division of Orthopaedic Trauma and Fracture Care, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Does a "July Effect" Exist for Fellowship Training in Total Hip and Knee Arthroplasty? J Arthroplasty 2020; 35:1208-1213. [PMID: 31987687 DOI: 10.1016/j.arth.2019.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/17/2019] [Accepted: 12/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The hypothetical association between health-care errors and the transition of the medical academic year has been termed the "July effect." Data supporting its existence are conflicting, particularly in orthopedic surgery, and prior studies have inappropriately grouped fellows with resident trainees. No studies to date have examined whether a training initiation effect exists among surgical fellows in adult reconstructive orthopedics. METHODS This is a level IV retrospective cohort study reviewing 15,650 primary hip and knee arthroplasties performed from 2006 to 2016 at a single institution. Forty arthroplasty fellows were trained during this 10-year period. Primary outcome measures included intraoperative complications, additional procedures, revisions, and nonoperative complications within 90 days of surgery. These complication rates were analyzed by quarter of academic year and by temporal progression through three-month fellowship rotations. RESULTS There were no differences in intraoperative complication, revision, or nonoperative complication rates between any academic quarter. There was a single statistically lower rate of additional procedures in the third quarter (1.2%) than in the fourth quarter (1.8%, P = .04). The most common complication in this subset was wound dehiscence for patients undergoing hip arthroplasty and stiffness for patients undergoing knee arthroplasty. There was no difference in complication rates during the first, second, or third month as fellows progressed through a single rotation. CONCLUSION This study does not support the existence of a training-initiation effect among fellows in adult hip and knee reconstruction. Graduated autonomy can be safely employed in a fellowship program without negatively impacting patient outcomes, ensuring the continued high-caliber training of future surgeons.
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Technical Obstacles in Total Knee Arthroplasty Learning: A Steps Breakdown Evaluation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e062. [PMID: 31858072 PMCID: PMC6917279 DOI: 10.5435/jaaosglobal-d-19-00062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Total knee arthroplasty (TKA) is a common procedure practiced in both the community and academic setting and one that all orthopaedic surgery residents are expected to become competent in. The aim of this study is to determine the most common technical obstacles encountered during TKA learning. Methods This is a prospective, cohort observational study performed from September 2017 to April 2018. After routine primary TKA, faculty completed a survey of the trainees in the case through a series of 10 questions. The questions were scored on a 0 to 5 scale based on performance proficiency. Exclusion criteria included revision TKA and complex primary TKA. Participants were divided into two groups based on year in training multiplied by the number of cases performed: group 1 (junior-n = 44) was <20, whereas group 2 (senior-n = 59) was >20. Results The senior experience group scored higher for all questions (P < 0.05). Skills competency and technique were related to each other, independent of experience. When evaluating the relationships between the steps, the scores on every step were linked to the previous and following step at all experience levels (P < 0.05), with some dictating the success of the rest of the case with high significance (P < 0.01). Conclusion We have shown that most senior-level residents cannot necessarily perform all steps of a TKA proficiently, potentially leading to issues in independent practice. We have also demonstrated that residents have the most difficulty with conceptual tasks, rather than technical ones. Teaching has traditionally focused on technical skills, but this implies conceptual tasks may require more teaching focus.
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Giordano L, Oliviero A, Peretti GM, Maffulli N. The presence of residents during orthopedic operation exerts no negative influence on outcome. Br Med Bull 2019; 130:65-80. [PMID: 31049559 DOI: 10.1093/bmb/ldz009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operative procedural training is a key component of orthopedic surgery residency. It is unclear how and whether residents participation in orthopedic surgical procedures impacts on post-operative outcomes. SOURCES OF DATA A systematic search was performed to identify articles in which the presence of a resident in the operating room was certified, and was compared with interventions without the presence of residents. AREAS OF AGREEMENT There is a likely beneficial role of residents in the operating room, and there is only a weak association between the presence of a resident and a worse outcome for orthopedic surgical patients. AREAS OF CONTROVERSY Most of the studies were undertaken in USA, and this represents a limit from the point of view of comparison with other academic and clinical realities. GROWING POINT The data provide support for continued and perhaps increased involvement of resident in orthopedic surgery. AREAS OF RESEARCH To clarify the role of residents on clinically relevant outcomes in orthopedic patients, appropriately powered randomized control trials should be planned.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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Singh P, Madanipour S, Fontalis A, Bhamra JS, Abdul-Jabar HB. A systematic review and meta-analysis of trainee- versus consultant surgeon-performed elective total hip arthroplasty. EFORT Open Rev 2019; 4:44-55. [PMID: 30931148 PMCID: PMC6404792 DOI: 10.1302/2058-5241.4.180034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Total hip arthroplasty (THA) is one of the most commonly performed orthopaedic procedures. Some concern exists that trainee-performed THA may adversely affect patient outcomes. The aim of this meta-analysis was to compare outcomes following THA performed by surgical trainees and consultant surgeons. A systematic search was performed to identify articles comparing outcomes following trainee- versus consultant-performed THA. Outcomes assessed included rate of revision surgery, dislocation, deep infection, mean operation time, length of hospital stay and Harris Hip Score (HHS) up to one year. A meta-analysis was conducted using odds ratios (ORs) and weighted mean differences (WMDs). A subgroup analysis for supervised trainees versus consultants was also performed. The final analysis included seven non-randomized studies of 40 810 THAs, of which 6393 (15.7%) were performed by trainees and 34 417 (84.3%) were performed by consultants. In total, 5651 (88.4%) THAs in the trainee group were performed under supervision. There was no significant difference in revision rate between the trainee and consultant groups (OR 1.09; p = 0.51). Trainees took significantly longer to perform THA compared with consultants (WMD 12.9; p < 0.01). The trainee group was associated with a lower HHS at one year compared with consultants (WMD -1.26; p < 0.01). There was no difference in rate of dislocation, deep infection or length of hospital stay between the two groups. The present study suggests that supervised trainees can achieve similar clinical outcomes to consultant surgeons, with a slightly longer operation time. In selected patients, trainee-performed THA is safe and effective.
Cite this article: EFORT Open Rev 2019;4:44-55. DOI: 10.1302/2058-5241.4.180034.
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Mrdutt MM, Weber RA, Burke LM, Thomas JS, Papaconstantinou HT, Cable CT. Financial Value Analysis of Surgical Residency Programs: An Argument Against Replacement. JOURNAL OF SURGICAL EDUCATION 2018; 75:e150-e155. [PMID: 30100323 DOI: 10.1016/j.jsurg.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To quantify the replacement cost of patient care provided by surgical residents and build a Graduate Medical Education (GME) value analysis model. DESIGN Our Graduate Medical Education Executive Steering Committee designed a resident replacement cost model, based on patient care hours (adjusted for educational activities and a clinical efficiency factor, differential cost of faculty supervision for residents vs. APPs, and current program financials (revenue minus expenses). Strategic value planning included: academic productivity (local and national conference presentations, book chapters and publications and Senior Staff recruitment and retention. SETTING Department of Surgery at Baylor Scott & White Medical Center, a tertiary institution located in Temple, TX. PARTICIPANTS Our replacement model was applied to a sample 30-position residency program. RESULTS Modeling a 30-position residency program, replacement cost approaches 4.5 million dollars, based on a 1:3 Senior Staff-to-APP replacement ratio. A complete APP replacement complement has a projected cost of 3.1 million dollars, while replacement with Senior Staff approaches 9 million dollars. CONCLUSIONS We present a novel model for residency value analysis allowing for reproducible and standardized results across multiple residency programs. Challenges inherent to GME, such as clinical efficiency and the cost of faculty supervision, are accounted for. Quantifying resident replacement cost and financial value is a powerful tool when discussing institutional workforce planning within the current financial climate of healthcare.
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Affiliation(s)
- M M Mrdutt
- Department of Surgery, Baylor Scott & White Medical Center, Temple Texas.
| | - R A Weber
- Department of Surgery, Baylor Scott & White Medical Center, Temple Texas.
| | - L M Burke
- Office of Academic Finance, Baylor Scott & White Medical Center, Temple Texas.
| | - J S Thomas
- Department of Surgery, Baylor Scott & White Medical Center, Temple Texas.
| | | | - C T Cable
- Graduate Medical Education, Baylor Scott & White Medical Center, Temple, Texas.
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Cowley RJ, Frampton C, Young SW. Operating time for total knee arthroplasty in public versus private sectors: where does the efficiency lie? ANZ J Surg 2018; 89:53-56. [DOI: 10.1111/ans.14905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/24/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Richard J. Cowley
- Department of Orthopaedics; Christchurch Hospital; Christchurch New Zealand
| | - Chris Frampton
- Department of Medicine; University of Otago; Dunedin New Zealand
| | - Simon W. Young
- Department of Orthopaedic Surgery; The University of Auckland; Auckland New Zealand
- Department of Orthopaedics; North Shore Hospital; Auckland New Zealand
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The hidden cost of training orthopaedic surgery residents to perform an open carpal tunnel release. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weber M, Worlicek M, Voellner F, Woerner M, Benditz A, Weber D, Grifka J, Renkawitz T. Surgical training does not affect operative time and outcome in total knee arthroplasty. PLoS One 2018; 13:e0197850. [PMID: 29856769 PMCID: PMC5983555 DOI: 10.1371/journal.pone.0197850] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 05/09/2018] [Indexed: 12/19/2022] Open
Abstract
Training the next generation of orthopaedic surgeons in total knee arthroplasty (TKA) is crucial, but might affect operative time and outcome. We hypothesized that the learning curve of residents in TKA has an impact on (1) operative time, (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of 738 primary TKAs from our institutional joint registry, operative time, complication rates, patient-reported outcome measures (EQ-5D, WOMAC) within the first year and responder rates for positive outcome as defined by the OMERACT-OARSI criteria were compared between trainee and senior surgeons differentiating between conventional and navigated TKA. Mean operative time was 69.5±18.5min for trainees compared to 77.3±25.8min for senior surgeons (95%CI of the difference 1.5-13.9min, p = 0.02) in conventional TKA and 80.4±22.1min to 84.1±27.6min (95%CI of the difference -0.9-8.2min, p = 0.12) for navigated TKA, respectively. Intraoperative fracture (p≥0.36), thrombosis (p≥0.90), neurological deficits (p≥0.90) and infection rates (p≥0.28) were comparably low in both groups. Patient-reported outcome measures one year after TKA were similar for trainee and senior surgeons with EQ-5D 0.83±0.17 to 0.80±0.21 (p = 0.25) and WOMAC 74.85±18.60 to 72.77±20.12 (p = 0.44) for conventional TKA and EQ-5D 0.80±0.20 to 0.82±0.18 (p = 0.23) and WOMAC 72.71±18.52 to 75.77±17.78 (p = 0.07) for navigated TKA, respectively. Similarly, responder rates for positive outcome were comparable between trainees and senior surgeons (90.7% versus 87.0% p = 0.39 for conventional TKA, 88.7% versus 89.4% p = 0.80 for navigated TKA). Supervised TKA is a safe procedure during the learning curve of young orthopaedic surgeons.
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Affiliation(s)
- Markus Weber
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
- * E-mail:
| | - Michael Worlicek
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Florian Voellner
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Michael Woerner
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Daniela Weber
- Department of Hematology and Oncology, Regensburg University, Medical Center, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University, Medical Center, Bad Abbach, Germany
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Benditz A, Maderbacher G, Zeman F, Grifka J, Weber M, von Kunow F, Greimel F, Keshmiri A. Postoperative pain and patient satisfaction are not influenced by daytime and duration of knee and hip arthroplasty: a prospective cohort study. Arch Orthop Trauma Surg 2017; 137:1343-1348. [PMID: 28776090 DOI: 10.1007/s00402-017-2769-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The number of total hip and knee arthroplasties (THA and TKA) is steadily increasing. Many factors that influence pain have been reported, but little is known about the correlation between the time of day and the duration of surgery and postoperative pain. On one hand, surgical interventions are performed faster due to economic pressure; on the other hand, obtaining sound surgical skills and a thorough education are most important for young surgeons, particularly at university hospitals. Amidst these different interests, it is the patient who should be the focus of all medical efforts. Therefore, our study investigated the effects of the time of day and the duration of total knee and hip arthroplasty on postoperative pain perception and patient satisfaction. METHODS 623 patients were analyzed 24 h after primary total knee or hip arthroplasty regarding pain, patient satisfaction, and side effects by means of the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Management (QUIPS). RESULTS The time of day and the duration of knee or hip arthroplasty were not correlated with maximum, minimum, and activity-related pain and patient satisfaction rated on a numeric rating scale (NRS). CONCLUSIONS This study is the first to show that neither the time of day nor the duration of surgery has any influence on patient satisfaction and postoperative pain 24 h after total knee or hip arthroplasty; regarding these aspects, young orthopaedic surgeons may be trained in the operating theatre without time pressure.
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Affiliation(s)
- A Benditz
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - G Maderbacher
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Frederik von Kunow
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
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Is Orthopedic Department Teaching Status Associated With Adverse Outcomes Of Primary Total Hip Arthroplasty? J Arthroplasty 2017; 32:S124-S127. [PMID: 28390883 DOI: 10.1016/j.arth.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/28/2017] [Accepted: 03/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although resident physicians play a vital role in the US health care system, they are believed to create inefficiencies in the delivery of care. Under the regional component of the Comprehensive Care for Joint Replacement model, teaching hospitals are forced to compete on efficiency and outcomes with nonteaching hospitals. METHODS We identified 86,021 patients undergoing elective primary total hip arthroplasty in New York State between January 1, 2009, and September 30, 2014. Outcomes included length and cost of the index admission, disposition, and 90-day readmission. Mixed-effects regression models compared teaching vs nonteaching orthopedic hospitals after adjusting for patient demographics, comorbidities, hospital, surgeon, and year of surgery. RESULTS Patients undergoing surgery at teaching hospitals had longer lengths of stay (β = 3.2%; P < .001) and higher costs of admission (β = 13.6%; P < .001). There were no differences in disposition status (odds ratio = 1.03; P = .779). The risk of 90-day readmission was lower for teaching hospitals (odds ratio = 0.89; P = .001). CONCLUSION Primary total hip arthroplasty at teaching orthopedic hospitals is characterized by greater utilization of health care resources during the index admission. This suggests that teaching hospitals may be adversely affected by reimbursement tied to competition on economic and clinical metrics. Although a certain level of inefficiency is inherent during the learning process, these policies may hinder learning opportunities for residents in the clinical setting.
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Weber M, Benditz A, Woerner M, Weber D, Grifka J, Renkawitz T. Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty. Sci Rep 2017; 7:6152. [PMID: 28733672 PMCID: PMC5522387 DOI: 10.1038/s41598-017-06530-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/14/2017] [Indexed: 11/25/2022] Open
Abstract
Training of young surgeons in total hip arthroplasty (THA) is crucial, but might affect operative time and outcome especially in minimally invasive (MIS) THA. We asked whether the learning curve of orthopaedic residents trained on MIS THA has an impact on (1) operative time (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of over 1000 MIS THAs from our institutional joint registry, operative time, complication rates, patient reported outcome measures (Western Ontario and McMaster Universities Arthritis Index [WOMAC] and Euro-Qol 5D-5L [EQ-5D]) within the first year and responder rates for positive outcome as defined by the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus responder (OMERACT-OARSI) criteria were compared between trainee and senior surgeons. Mean operative time was nine minutes longer for trainees compared to senior surgeons (78.1 ± 25.4 min versus 69.3 ± 23.8 min, p < 0.001). Dislocation (p = 0.21), intraoperative fracture (p = 0.84) and infection rates (p = 0.58) were comparably low in both groups. Both trainee and senior THAs showed excellent improvement of EQ-5D (0.34 ± 0.26 versus 0.32 ± 0.23, p = 0.40) and WOMAC (45.9 ± 22.1 versus 44.9 ± 20.0, p = 0.51) within the first year after surgery without clinical relevant differences. Similarly, responder rates for positive outcome were comparable between trainees with 92.9% and senior surgeons with 95.2% (p = 0.17). MIS THA seems to be a safe procedure during the learning curve of young orthopaedic specialists, but requires higher operative time.
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Affiliation(s)
- Markus Weber
- Department of Orthopedic Surgery, Regensburg University, Medical Centre, Bad Abbach, Germany.
| | - Achim Benditz
- Department of Orthopedic Surgery, Regensburg University, Medical Centre, Bad Abbach, Germany
| | - Michael Woerner
- Department of Orthopedic Surgery, Regensburg University, Medical Centre, Bad Abbach, Germany
| | - Daniela Weber
- Department of Haematology and Oncology, Regensburg University, Medical Centre, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University, Medical Centre, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Regensburg University, Medical Centre, Bad Abbach, Germany
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Ferguson PC, Caverzagie KJ, Nousiainen MT, Snell L. Changing the culture of medical training: An important step toward the implementation of competency-based medical education. MEDICAL TEACHER 2017; 39:599-602. [PMID: 28598749 DOI: 10.1080/0142159x.2017.1315079] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education. MATERIALS AND METHODS At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic. RESULTS There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME. CONCLUSIONS The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.
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Affiliation(s)
- Peter C Ferguson
- a Division of Orthopaedic Surgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Kelly J Caverzagie
- b Division of General Internal Medicine, Department of Internal Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - Markku T Nousiainen
- a Division of Orthopaedic Surgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Linda Snell
- c Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Quebec , Canada
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
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Operative Intervention of Supracondylar Humerus Fractures More Complicated in July: Analysis of the July Effect. J Pediatr Orthop 2017; 37:254-257. [PMID: 26280293 DOI: 10.1097/bpo.0000000000000618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The "July Effect" involves the influx of new interns and residents early in the academic year (July and August), which may have greater potential for poorer patient outcomes. Current orthopaedic literature does not demonstrate the validity of this concept in arthroplasty, spine, hand, and arthroscopy. No study has investigated the possibility of this effect on common pediatric orthopaedic procedures, such as closed reduction and percutaneous pin fixation of supracondylar humerus fractures. METHODS A retrospective review of all type II or III supracondylar humerus fractures that underwent primary closed reduction and percutaneous pin fixation (CPT code 24538) at a single pediatric level 1 trauma center from July 2009 to June 2013. Patients were grouped according to time in the academic year: early (July and August) and late (May and June). Demographic data included length of follow-up, age at surgery, sex, side of injury, and Wilkin's modified Gartland classification. Outcomes included length of operation, number of pins used, length of stay, complications, and the need for repeat surgery. RESULTS There were 245 patients, 101 in the early and 144 in the late group. There was no increase in surgical time [33.32±24.74 (early) vs. 28.63±10.06 (late) min, P=0.07) or complication rates [7.0% (early) vs. 2.1% (late), P=0.06) between the early and the late groups. Cases performed with junior residents demonstrated longer operative (31.72±17.07 vs. 28.96±18.71 min, P=0.02) and fluoroscopy (48.63±30.96 vs. 34.12±27.38 s, P=0.01) times. CONCLUSIONS The academic orthopaedic surgeon must ensure the education of residents, while providing the highest level of safety to patients. Our study shows that education of young residents early in the academic year results in no increase in operative times, radiation exposure, or complications. LEVEL OF EVIDENCE Level III.
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Reidy MJ, Faulkner A, Shitole B, Clift B. Do trainee surgeons have an adverse effect on the outcome after total hip arthroplasty?: a ten-year review. Bone Joint J 2016; 98-B:301-6. [PMID: 26920953 DOI: 10.1302/0301-620x.98b3.35997] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The long-term functional outcome of total hip arthroplasty (THA) performed by trainees is not known. A multicentre retrospective study of 879 THAs was undertaken to investigate any differences in outcome between those performed by trainee surgeons and consultants. PATIENTS AND METHODS A total of 879 patients with a mean age of 69.5 years (37 to 94) were included in the study; 584 THAs (66.4%) were undertaken by consultants, 138 (15.7%) by junior trainees and 148 (16.8%) by senior trainees. Patients were scored using the Harris Hip Score (HHS) pre-operatively and at one, three, five, seven and ten years post-operatively. Surgical outcome, complications and survival were compared between groups. The effect of supervision was determined by comparing supervised and unsupervised trainees. A primary univariate analysis was used to select variables for inclusion in multivariate analysis. RESULTS There was no evidence that the grade of the surgeon had a significant effect on the survival of the patients or the rate of revision (p = 0.987 and 0.405, respectively) up to 12 years post-operatively. There was no significant difference in post-operative functional HHS or total HHS among consultants, junior and seniors up to ten years post-operatively (p = 0.401 and 0.331), respectively. There was no significant difference in hospital stay (p = 0.855) between different grades of surgeons. There was no evidence that the level of supervision had an effect on the survival of the patients or the rate of revision (p = 0.837 and 0.203, respectively) up to 12 years post-operatively. There was no significant difference between supervised and unsupervised trainee groups in post-operative functional HHS or total HHS up to ten years post-operatively (p = 0.213 and 0.322, respectively). There was no significant difference in the mean hospital stay between supervised and unsupervised trainees (p = 0.908). TAKE HOME MESSAGE This study suggests that when trainees are appropriately supervised, they can obtain results comparable with those of their consultant colleagues when performing THA.
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Affiliation(s)
- M J Reidy
- Ninewells Hospital, Dundee DD1 9SY, UK
| | | | - B Shitole
- Ninewells Hospital, Dundee DD1 9SY, UK
| | - B Clift
- Ninewells Hospital, Dundee DD1 9SY, UK
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Dougherty PJ, DeMaio M, DeRosa GP. CORR® curriculum — orthopaedic education: developing safe, independent practitioners. Clin Orthop Relat Res 2015; 473:3710-13. [PMID: 26463570 PMCID: PMC4626493 DOI: 10.1007/s11999-015-4582-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/30/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Paul J Dougherty
- Detroit Medical Center and Wayne State University, 4201 St. Antoine, Suite 4G, Detroit, MI 48201, USA.
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Mahmoudi A, Noomen F, Nasr M, Zouari K, Hamdi A. [Evaluation of residency training in general and digestive surgery in Tunisia]. Pan Afr Med J 2015; 21:328. [PMID: 26587174 PMCID: PMC4633808 DOI: 10.11604/pamj.2015.21.328.6604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/17/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction De nombreux moyens sont mis à disposition des résidents en chirurgie générale et digestive pour assurer leur formation théorique et pratique. Cependant, le niveau d'utilisation de ces différents outils et leur impact sur la formation des résidents n'ont jamais été évalués. L'objectif de notre étude était d’étudier l’état des lieux des moyens de formation utilisés par les résidents pour évaluer leurs degrés de satisfaction et leurs propositions en vue d'améliorer leur formation. Méthodes Un questionnaire anonyme a été distribué aux résidents de chirurgie générale et digestive de l'année 2012-2013. Ce questionnaire portait sur les caractéristiques démographiques, les ressources pédagogiques, ainsi que le cursus médical et universitaire. Une évaluation de la formation ainsi qu'un recueil des propositions faites en vue d'améliorer leurs formations étaient réalisées. Résultats Cinquante résidents sur 83 ont répondu au questionnaire. L'orientation de carrière la plus fréquente était l'hospitalo-universitaire dans 70% des cas. La pratique quotidienne et l'internet étaient les deux ressources pédagogiques les plus utilisées. La formation chirurgicale était jugée satisfaisante par seulement 10% des répondants. Parmi l'ensemble des propositions faites, l'apprentissage sur simulateur chirurgical, l'existence d'un ouvrage national de référence, et l'institution d'un tutorat par un chirurgien senior recueillaient plus de 80% d'avis favorable. Conclusion La majorité des résidents jugent leur formation non satisfaisante. Une meilleure information sur les ressources déjà existantes, un renforcement du compagnonnage et un accès plus large à un apprentissage sur simulateur chirurgical permettraient de diminuer ce sentiment d'insatisfaction.
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Affiliation(s)
- Ammar Mahmoudi
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Faouzi Noomen
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Mohamed Nasr
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Khadija Zouari
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Abdelaziz Hamdi
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
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Oker N, Escabasse V, Al-Otaibi N, Coste A, Albers AE. Acquisition of diagnostic and surgical skills in otorhinolaryngology: a comparison of France and Germany. Eur Arch Otorhinolaryngol 2015; 272:3565-73. [DOI: 10.1007/s00405-015-3632-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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Haughom BD, Schairer WW, Hellman MD, Yi PH, Levine BR. Resident involvement does not influence complication after total hip arthroplasty: an analysis of 13,109 cases. J Arthroplasty 2014; 29:1919-24. [PMID: 24997650 DOI: 10.1016/j.arth.2014.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/05/2014] [Accepted: 06/03/2014] [Indexed: 02/01/2023] Open
Abstract
Our study aimed to determine the impact of resident involvement on the 30-day postoperative complication rates following primary total hip arthroplasty (THA). Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, 13,109 primary THAs were identified, of which 3462 (26.4%) had resident involvement. Neither univariate (4.45% vs 4.52%, P = 0.86) nor multivariate (OR 1.04, P = 0.75) analyses demonstrated an increased complication rate with resident involvement following THA. We did find, however, that increased operative time, comorbidities, age, obesity, prior history of stroke and/or cardiac surgery were all independent risk factors for short-term complication. Our findings suggest that resident involvement does not increase 30-day complication rates following primary THA.
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Affiliation(s)
- Bryan D Haughom
- Department of Orthopaedic Surgery, Rush University, Chicago, Illinois
| | - William W Schairer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Michael D Hellman
- Department of Orthopaedic Surgery, Rush University, Chicago, Illinois
| | - Paul H Yi
- Boston University School of Medicine, Boston, Massachusetts
| | - Brett R Levine
- Department of Orthopaedic Surgery, Rush University, Chicago, Illinois
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Edelstein AI, Lovecchio FC, Saha S, Hsu WK, Kim JYS. Impact of Resident Involvement on Orthopaedic Surgery Outcomes: An Analysis of 30,628 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database. J Bone Joint Surg Am 2014; 96:e131. [PMID: 25100784 DOI: 10.2106/jbjs.m.00660] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operative procedural training is a key component of orthopaedic surgery residency. The influence of intraoperative resident participation on the outcomes of surgery has not been studied extensively using large, population-based databases. METHODS We identified 30,628 patients who underwent orthopaedic procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program. Outcomes as measured by perioperative complications, readmission rates, and mortality within thirty days were compared for cases with and without intraoperative resident involvement. RESULTS Logistic regression with propensity score analysis revealed that intraoperative resident participation was associated with decreased rates of overall complications (odds ratio, 0.717 [95% confidence interval, 0.657 to 0.782]), medical complications (odds ratio, 0.723 [95% confidence interval, 0.661 to 0.790]), and mortality (odds ratio, 0.638 [95% confidence interval, 0.427 to 0.951]). Resident presence in the operating room was not predictive of wound complications (odds ratio, 0.831 [95% confidence interval, 0.656 to 1.053]), readmission (odds ratio, 0.962 [95% confidence interval, 0.830 to 1.116]), or reoperation (odds ratio, 0.938 [95% confidence interval, 0.758 to 1.161]). A second analysis by propensity score stratification into quintiles grouped by similar probability of intraoperative resident presence showed resident involvement to correlate with decreased rates of overall and medical complications in three quintiles, but increased rates of overall and medical complications in one quintile. All other outcomes were equivalent across quintiles. CONCLUSIONS Orthopaedic resident involvement during surgical procedures is associated with lower risk of perioperative complications and mortality in the National Surgical Quality Improvement Program database. The results support resident participation in the operative care of orthopaedic patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam I Edelstein
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - Francis C Lovecchio
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - Sujata Saha
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - Wellington K Hsu
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
| | - John Y S Kim
- Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
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Oker N, Escabasse V, Pensky H, Alotaibi N, Coste A, Albers AE. Training satisfaction and work environment in Otorhinolaryngology, Head and Neck surgery: a comparison between France and Germany. Eur Arch Otorhinolaryngol 2014; 271:2565-73. [PMID: 24777563 DOI: 10.1007/s00405-014-3046-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
Abstract
With the coalescing of Europe, increased mobility of professionals emerges. Initiatives to harmonize medical education were launched. In Otolaryngology, Head and Neck surgery (ORL) an European board examination was created to ensure standards. Quality of training, satisfaction and quality of life of residents and recent ORL specialists were compared to assess different aspects of work and hierarchical relationships in France (FRA) and Germany (GER) by means of an anonymous questionnaire. 120 FRA and 125 GER questionnaires were included. 78 % of respondents were residents. 86 % would choose the same training again. In both countries, a majority felt well considered with responsibilities adapted to their level of training and with supportive supervisors. Germans reported average daily work hours of 9.6 versus 11 in FRA with compensated overtime (76 %) and a possibility of part-time work (62 %), both nearly inexistent in FRA. In GER, the day-off after duty was more often respected. French attributed their seniors better pedagogic skills, taking time for explanations and providing better teaching. Offering a good training was a more important objective in French training centers (77 vs. 51 %). In both countries, surgical training relied on coaching. Research activities were comparable. The overall satisfaction with ORL training was high. Differences concerned structure of training, guidance by senior doctors and the working conditions. The study results provide guidance before choosing a program and may help to improve current training by identifying positive aspects that, if combined could lead to a convergence of programs. However, present high standards of education must be maintained.
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Affiliation(s)
- Natalie Oker
- Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
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An Overview of Virtual Simulation and Serious Gaming for Surgical Education and Training. STUDIES IN COMPUTATIONAL INTELLIGENCE 2014. [DOI: 10.1007/978-3-642-45432-5_14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Schoenfeld AJ, Serrano JA, Waterman BR, Bader JO, Belmont PJ. The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg 2013; 133:1483-91. [PMID: 23995548 DOI: 10.1007/s00402-013-1841-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND Few studies have addressed the role of residents' participation in morbidity and mortality after orthopaedic surgery. The present study utilized the 2005-2010 National Surgical Quality Improvement Program (NSQIP) dataset to assess the risk of 30-day post-operative complications and mortality associated with resident participation in orthopaedic procedures. METHODS The NSQIP dataset was queried using codes for 12 common orthopaedic procedures. Patients identified as having received one of the procedures had their records abstracted to obtain demographic data, medical history, operative time, and resident involvement in their surgical care. Thirty-day post-operative outcomes, including complications and mortality, were assessed for all patients. A step-wise multivariate logistic regression model was constructed to evaluate the impact of resident participation on mortality- and complication-risk while controlling for other factors in the model. Primary analyses were performed comparing cases where the attending surgeon operated alone to all other case designations, while a subsequent sensitivity analysis limited inclusion to cases where resident participation was reported by post-graduate year. RESULTS In the NSQIP dataset, 43,343 patients had received one of the 12 orthopaedic procedures queried. Thirty-five percent of cases were performed with resident participation. The mortality rate, overall, was 2.5 and 10 % sustained one or more complications. Multivariate analysis demonstrated a significant association between resident participation and the risk of one or more complications [OR 1.3 (95 % CI 1.1, 1.4); p < 0.001] as well as major systemic complications [OR 1.6 (95 % CI 1.3, 2.0); p < 0.001] for primary joint arthroplasty procedures only. These findings persisted even after sensitivity testing. CONCLUSIONS A mild to moderate risk for complications was noted following resident involvement in joint arthroplasty procedures. No significant risk of post-operative morbidity or mortality was appreciated for the other orthopaedic procedures studied. LEVEL OF EVIDENCE II (Prognostic).
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras Street, El Paso, TX, 79920, USA,
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Grant JA, Bissell B, Hake ME, Miller BS, Hughes RE, Carpenter JE. Relationship between implant use, operative time, and costs associated with distal biceps tendon reattachment. Orthopedics 2012; 35:e1618-24. [PMID: 23127453 DOI: 10.3928/01477447-20121023-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The suture anchor and transosseous drill hole techniques for reattachment of the distal biceps tendon to the radius have been found to have similar clinical and biomechanical outcomes. However, a comparison of the cost effectiveness of these techniques is lacking. The purpose of this study was to determine whether the use of suture anchors decreases operative time enough to offset the additional cost of the implants. The records of all patients undergoing a distal biceps tendon reattachment were reviewed to determine the method of fixation, operative time, and associated surgical costs. Two surgeons used a technique of fixing the tendon directly to the bone (transosseous group), whereas 3 surgeons used suture anchors. Given the standard nature of the surgical procedure (other than the fixation technique), only the costs that differed between the 2 groups were included. Surgical center costs were obtained from the local outpatient surgical center in 2011 US dollars. Five surgeons treated 70 men (mean age, 45.9±9.2 years). Mean time from injury to surgery was 14 days. Mean operative times for the transosseous and suture anchor groups were 97.6±14.9 and 95.8±25.8 minutes, respectively (P=.74). Two anchors were used in 79% of the anchor cases. The use of anchors cost $474.33 more per patient. However, this value is sensitive to the cost of the individual anchors, intersurgeon variation in operative time, and per-minute value of saved operative time. No operative time was saved with the use of suture anchors. This cost comparison framework can be used to evaluate the balance in surgical resource use due to implant cost vs savings in operative time.
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Affiliation(s)
- John A Grant
- Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
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Naiditch JA, Lautz TB, Raval MV, Madonna MB, Barsness KA. Effect of Resident Postgraduate Year on Outcomes After Laparoscopic Appendectomy for Appendicitis in Children. J Laparoendosc Adv Surg Tech A 2012; 22:715-9. [PMID: 22845738 DOI: 10.1089/lap.2012.0032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jessica A. Naiditch
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy B. Lautz
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mehul V. Raval
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Beth Madonna
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine A. Barsness
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Myden CA, Anglin C, Kopp GD, Hutchison CR. Computer-assisted surgery simulations and directed practice of total knee arthroplasty: educational benefits to the trainee. ACTA ACUST UNITED AC 2012; 17:113-27. [PMID: 22489936 DOI: 10.3109/10929088.2012.671365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Orthopaedic residents typically learn to perform total knee arthroplasty (TKA) through an apprenticeship-type model, which is a necessarily slow process. Surgical skills courses, using artificial bones, have been shown to improve technical and cognitive skills significantly within a couple of days. The addition of computer-assisted surgery (CAS) simulations challenges the participants to consider the same task in a different context, promoting cognitive flexibility. We designed a hands-on educational intervention for junior residents with a conventional tibiofemoral TKA station, two different tibiofemoral CAS stations, and a CAS and conventional patellar resection station, including both qualitative and quantitative analyses. Qualitatively, structured interviews before and after the course were analyzed for recurring themes. Quantitatively, subjects were evaluated on their technical skills before and after the course, and on a multiple-choice knowledge test and error detection test after the course, in comparison to senior residents who performed only the testing. Four themes emerged: confidence, awareness, deepening knowledge and changed perspectives. The residents' attitudes to CAS changed from negative before the course to neutral or positive afterwards. The junior resident group completed 23% of tasks in the pre-course skills test and 75% of tasks on the post-test (p<0.01), compared to 45% of tasks completed by the senior resident group. High-impact educational interventions, promoting cognitive flexibility, would benefit trainees, attending surgeons, the healthcare system and patients.
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Affiliation(s)
- C A Myden
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta. Canada
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Kasch R, Merk S, Drescher W, Schulz AP, Kayser R, Skripitz R, Fröhlich S, Lahm A, Merk H, Fleßa S. Marginal contribution of UKS- versus TKA in varus arthritis of the knee. Arch Orthop Trauma Surg 2012; 132:1165-72. [PMID: 22643803 DOI: 10.1007/s00402-012-1535-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, decisions regarding the treatment of individual patients have increasingly been affected by economic considerations. The G-DRG system reimburses sledge endoprosthetic implantations at a much lower rate than surface replacements and at significantly different cost weights (CW). Therefore, when only G-DRG payments are considered, TKA produces higher gains. Taking only these revenues alone into consideration, however, does not provide the basis of an economically sound decision-making process. The target of this research was to present a comparison between variable costs of the two procedures. METHODS The mean cost and performance data of 28 Endo-Modell (Link company) sledge implantations (UKS) and of 85 NexGen CR surface replacement total knee arthroplasties (TKA; Zimmer company) were compared in 2007. RESULTS From the perspective of the hospital, UKS treatment is of greater economic advantage when the medical indication is given. In preferring UKS marginal contribution can be improved, and although the relative weighting is comparatively low, the costs are significantly lower than in a comparative analysis of TKA. Based on the length of stay required for each procedure the average daily CW for UKS can be calculated as 0.1728, while being 0.1955 for TKA. The earlier release of the first patient results in another patient being admitted 1.5 days earlier and thus an increase in case mix. Meanwhile, the case-mix index and the costs of care per case decrease ceteris paribus. CONCLUSION Assuming the correct medical indication, the hospital seeking to maximize its marginal contribution would be wise to select sledge endoprosthesis implantation. Considering the economic perspective of gains and costs, the assumption that TKA is advantageous could not be confirmed in the present study.
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Affiliation(s)
- Richard Kasch
- Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.
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Guss D, Prestipino AL, Rubash HE. Graduate medical education funding: a Massachusetts General Hospital case study and review. J Bone Joint Surg Am 2012; 94:e24. [PMID: 22336983 DOI: 10.2106/jbjs.k.00425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
During the past century, graduate medical education funding has evolved in response to the increasing specialization of modern medicine as well as the need for federal funding to effectively sustain specialty training. This article reviews historical and current funding methods for graduate medical education and examines current funding using Massachusetts General Hospital (MGH) as a case example. Notably, it also explores whether graduate medical education funding at a large academic center such as MGH is commensurate with expenditures.
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Affiliation(s)
- Daniel Guss
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, WHT-5-535, Boston, MA 02114, USA.
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Abstract
BACKGROUND To meet Australia's future demands, surgical training in the private sector will be required. The aim of this study was to estimate the time and lost opportunity cost of training in the private sector. METHODS A literature search identified studies that compared the operation time required by a supervised trainee with a consultant. This time was costed using a business model. RESULTS In 22 studies (34 operations), the median operation duration of a supervised trainee was 34% longer than the consultant. To complete a private training list in the same time as a consultant list, one major case would have to be dropped. A consultant's average lost opportunity cost was $1186 per list ($106,698 per year). Training in rooms and administration requirements increased this to $155,618 per year. To train 400 trainees in the private sector to college standards would require 54,000 training lists per year. The consultants' national lost opportunity cost would be $137 million per year. The average lost hospital case payment was $5894 per list, or $330 million per year nationally. The total lost opportunity cost of surgical training in the private sector would be about $467 million per year. When trainee salaries, other specialties and indirect expenses are included, the total cost will be substantially greater. CONCLUSION It is unlikely that surgeons or hospitals will be prepared to absorb these costs. There needs to be a public debate about the funding implications of surgical training in the private sector.
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Affiliation(s)
- R James Aitken
- Hollywood Medical Centre, Nedlands, Western Australia, Australia.
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Schnurr C, Eysel P, König DP. Do residents perform TKAs using computer navigation as accurately as consultants? Orthopedics 2011; 34:174. [PMID: 21410131 DOI: 10.3928/01477447-20110124-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The implantation of a total knee arthroplasty (TKA) is a milestone in a resident's surgical training. Studies demonstrate higher loosening rates after TKA by inexperienced surgeons. Alignment outliers should be avoided to achieve a long implant survival. Therefore, our study questioned whether residents implant knee prostheses using computer navigation as accurately as experienced consultants. The data for 662 consecutive TKAs were analyzed retrospectively. The operations were performed by 4 consultants (n=555) and 5 residents under supervision by a consultant (n=107). Cutting errors were recorded from the navigation data. The postoperative mechanical axis and operation time were recorded. Operation time was significantly prolonged if residents performed the operation vs consultants (139 vs 122 minutes, respectively). The analysis of cutting errors within each surgeon's first 20 navigated operations resulted in no significant difference between residents and consultants. During the subsequent operations, a trend toward a more accurate placement of the prosthesis was detected for consultants. The rate of outliers with a mechanical axis deviation >2° was low and did not significantly differ between residents and consultants (3.7% vs 2.3%, respectively). Our study shows that residents implant their first TKA using computer navigation as accurately as experienced consultants. However, the residents' operations take longer and therefore incur additional costs for the teaching clinic.
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Malekzadeh D, Osmon DR, Lahr BD, Hanssen AD, Berbari EF. Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection. Clin Orthop Relat Res 2010; 468:2039-45. [PMID: 20401555 PMCID: PMC2895855 DOI: 10.1007/s11999-010-1338-0] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical characteristics and control of the infection of patients with culture-negative (CN) prosthetic joint infection (PJI) have not been well assessed. Prior use of antimicrobial therapy has been speculated but not proven as a risk factor for CNPJI. QUESTIONS/PURPOSES We therefore determined whether prior use of antimicrobial therapy, prior PJI, and postoperative wound healing complications were associated with CN PJI. METHODS We performed a retrospective case-control study of 135 patients with CN PJI treated between January 1, 1985, and December 31, 2000 matched with 135 patients with culture-positive (CP) PJIs (control patients) during the study period. The time to failure of therapy compared between cases and control patients using a Kaplan-Meier analysis. RESULTS The use of prior antimicrobial therapy and postoperative wound drainage after index arthroplasty were associated with increased odds of PJI being culture-negative (odds ratio, 4.7; 95% CI, 2.8-8.1 and odds ratio, 3.5; 95% CI, 1.5-8.1, respectively). The percent (+/- SE) cumulative incidence free of treatment failure at 2 years followup was similar for CN and CP PJI: 75% (+/- 4%) and 79% (+/- 4%), respectively. CONCLUSIONS Prior antimicrobial therapy and postoperative wound drainage were associated with an increased risk of negative cultures among patients with PJI. Physicians should critically evaluate the need for antimicrobial therapy before establishing a microbiologic diagnosis of PJI in patients with suspected PJI. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Douglas R. Osmon
- Section of Orthopedic Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street NW, Rochester, MN 55902 USA
| | - Brian D. Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN USA
| | - Arlen D. Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Elie F. Berbari
- Section of Orthopedic Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street NW, Rochester, MN 55902 USA
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The cost of resident education. J Surg Res 2010; 163:18-23. [PMID: 20605595 DOI: 10.1016/j.jss.2010.03.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 02/08/2010] [Accepted: 03/04/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients cared for by surgeons with resident coverage have an increase in cost versus those patients cared for by surgeons without resident coverage, despite no significant difference in complications. We evaluated the reasons for the disparate cost. METHODS In a single institutional analysis, patients received their care from a group of eight surgeons, four with and four without resident coverage. We analyzed ancillary costs, including pharmacy, radiology, laboratory, and central supply costs, and length of stay, total cost, and hospital margin for these patients. In a separate analysis, we compared data that contributes to cost from the National Surgical Quality Improvement Program (NSQIP) database, including age in years, ASA class I-IV, total operating room time in minutes (min), length of hospital stay in days (d), number of patients with a return to OR in 30 d, and complications. RESULTS There were no significant differences in ancillary costs in patients cared for by residents. The length of stay was longer in patients cared for by residents (3.3 versus 4.6 d, no resident versus resident, respectively, P = 0.0001). When adjusted for the length of stay, the difference between total costs was $1949/d versus $2103/d (P = NS) for the no resident versus resident groups, respectively. There were 32,685 patients evaluated in the NSQIP database. In all comparisons, operating room time was significantly longer in patients with procedures involving residents. CONCLUSION The increase in cost in patients cared for by surgeons with residents is not from significant differences in ancillary costs, and may be from length of stay. Surgical procedures are significantly longer with resident involvement.
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Sabri H, Cowan B, Kapralos B, Porte M, Backstein D, Dubrowskie A. Serious games for knee replacement surgery procedure education and training. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.sbspro.2010.03.539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 2009; 210:60-5.e1-2. [PMID: 20123333 DOI: 10.1016/j.jamcollsurg.2009.09.034] [Citation(s) in RCA: 266] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 09/18/2009] [Accepted: 09/21/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Studies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures. STUDY DESIGN We queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection, sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class. RESULTS In 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk increased for each half hour of OD relative to cases lasting <or=1 hour, almost doubling at 2.1 to 2.5 hours (odds ratio = 1.92; 95% CI, 1.82 to 2.03; p < 0.001). In isolated laparoscopic cholecystectomy, IC rates increased linearly with OD (n = 17,018, chi-square test for linear trend, p < 0.001) with rates for 1.1 to 1.5 hour cases (1.4%) doubling those lasting <or=0.5 hour (0.7%). Across all procedures, adjusted LOS increased geometrically with operative duration at a rate of about 6% per half hour (coefficient for natural log transformed LOS = 0.059 per half hour; 95% CI, 0.058 to 0.060; p < 0.001). CONCLUSIONS Operative duration is independently associated with increased ICs and LOS after adjustment for procedure and patient risk factors.
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McColl RJ, Karmali S, Reso A, Paolucci E, Sherman V. The effect of a focused instructional session on knowledge of surgical staplers in general surgery residents. JOURNAL OF SURGICAL EDUCATION 2009; 66:288-291. [PMID: 20005503 DOI: 10.1016/j.jsurg.2009.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/18/2009] [Accepted: 08/28/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Surgical stapling devices have been used for a variety of purposes in both laparoscopic and open surgery. Nevertheless, trainees rarely receive any focused instruction on their application and use. This study attempts to determine the baseline knowledge of surgical stapling devices possessed by surgical residents. Furthermore, we attempt to evaluate the effectiveness of a short didactic session in improving the trainee's knowledge of the use and function of surgical staplers. METHODS A 20-question multiple-choice test was created to evaluate a general surgery resident's knowledge on the design and use of circular, linear, and laparoscopic surgical staplers. The test was administered before and after attending a 40-minute instructional session on surgical stapling devices. The tests were then scored by a data analyst. RESULTS A total of 26 residents of 39 in the residency program (26/39, 67%) participated. The pretest mean was 10.62/20 (53%), whereas the posttest mean was 15.38/20 (77%). These results were significantly different on paired samples t-test analysis (t((25)) = -10.3; p < 0.05). The mean pretest scores were also significantly different between resident levels (R1-R2, 9.50; R3-R5, 11.31; t((24)) = -2.10; p < 0.05). Senior-level residents scored higher on posttest analysis, but this result was not significant (R1-R2, 14.70; R3-R5, 15.81; t((24)) = -1.63; p > 0.05). DISCUSSION There is a deficiency of knowledge of surgical staplers in general surgery residents, more so in junior residents. Didactic instruction is effective in raising the level of knowledge of surgical staplers in all residents, up to a similar level. Surgical educators should consider implementing programs like these for staplers and other types of surgical equipment.
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Affiliation(s)
- Ryan J McColl
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Abstract
The author asked whether THA cases performed with major resident participation in a private practice setting were associated with greater use of health care resources, higher rates of technical errors, or a reduction in quality of outcome compared to THA cases performed without major resident involvement. Eighty-eight primary THA cases performed with major resident participation were compared to 61 cases without major resident participation. Resident cases took 20 minutes longer, required a second assistant more frequently (92% versus 23%) but did not have higher transfusion rates or result in a longer hospital stay. Resident cases did not have more complications or increased technical errors. Resident cases also did not have lower Harris hip scores or inferior Short Form SF-12 physical ratings at minimum 1-year followup.
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Woolson ST, Kang MN. A comparison of the results of total hip and knee arthroplasty performed on a teaching service or a private practice service. J Bone Joint Surg Am 2007; 89:601-7. [PMID: 17332109 DOI: 10.2106/jbjs.f.00584] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Active participation of residents and fellows in the performance of total hip and total knee arthroplasties may affect the outcomes of these procedures. We evaluated the early clinical results and complications associated with primary total hip and knee arthroplasties at a hospital that had both university teaching and private practice orthopaedic services. METHODS We performed a retrospective study on a consecutive series of 347 patients who had undergone 230 total hip and 171 total knee procedures performed by one attending surgeon. One hundred and sixty-nine patients underwent an arthroplasty during which a resident or fellow on a teaching service assisted the attending surgeon; during these procedures, the resident or fellow performed part of the arthroplasty under the direct supervision of the attending surgeon. Subsequently, 178 patients underwent an arthroplasty performed by the same surgeon without resident or fellow participation. RESULTS Significantly longer operative times were recorded for both total hip arthroplasty (average, seventy-three compared with sixty-one minutes; p < 0.0001) and total knee arthroplasty (average, eighty compared with seventy-three minutes; p = 0.0028) when the procedures were performed with the participation of residents or fellows. For total hip arthroplasty the complication rates were 8% for the teaching service and 10% for the private practice service, and for total knee arthroplasty they were 3% for each service. With the numbers studied, there were no differences in any clinical outcomes between the groups. CONCLUSIONS Teaching and active participation from residents and fellows during total hip and total knee arthroplasty did not have a detrimental effect on the early clinical results, except for a longer surgical time.
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Affiliation(s)
- Steven T Woolson
- Stanford University Medical Center, R144, Stanford, CA 94305, USA.
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