TY - JOUR
T1 - The Impact of Resident Involvement on Outcomes and Costs in Elective Hand and Upper Extremity Surgery
AU - Meyer, Maximilian A
AU - Tarabochia, Matthew A
AU - Goh, Brian C
AU - Hietbrink, Falco
AU - Houwert, R Marijn
AU - Dyer, George S M
N1 - Funding Information:
This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR002541) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.
Publisher Copyright:
© 2023
PY - 2023/8
Y1 - 2023/8
N2 - PURPOSE: The purpose of this study was to assess the impact of resident involvement on periprocedural outcomes and costs after common procedures performed at an academic hand surgical practice.METHODS: A retrospective review was performed in all patients undergoing 7 common elective upper extremity procedures between January 2008 and December 2018: carpal tunnel release, distal radius open reduction and internal fixation (ORIF), trigger finger release, thumb carpometacarpal arthroplasty, phalanx closed reduction and percutaneous pinning, cubital tunnel release, and olecranon ORIF. The medical record was reviewed to determine the impact of surgical assistants (resident, fellow, or physician assistant) on periprocedural outcomes, periprocedural costs, and 1-year postoperative outcomes. The involvement of surgical trainees operating under direct supervision was compared with the entire operation performed by the attending surgeon with a physician assistant present.RESULTS: A total of 396 procedures met the inclusion criteria. Analysis of the whole study sample revealed low rates of intraoperative complications, wound complications, medical complications, readmissions, and mortality. Subgroup analysis of carpal tunnel releases revealed significantly greater tourniquet times for residents compared with physician assistants (7 ± 2 min, 6 ± 1 min), as well as longer overall operating room times for residents compared to fellows or physician assistants (17 ± 5 min, 13 ± 3 min, 12 ± 3 min). Operating room times for distal radius ORIF were significantly greater among residents compared to fellows or physician assistants (68 ± 19 min, 57 ± 17 min, 56 ± 14 min). There were no differences in any other perioperative metrics or periprocedural costs for the trigger finger release or cubital tunnel release cohorts.CONCLUSIONS: Resident involvement in select upper extremity procedures can lengthen operative times but does not have an impact on blood loss or operating room costs.CLINICAL RELEVANCE: Surgeons should be aware that having a resident assistant slightly increases operative times in elective hand surgery.
AB - PURPOSE: The purpose of this study was to assess the impact of resident involvement on periprocedural outcomes and costs after common procedures performed at an academic hand surgical practice.METHODS: A retrospective review was performed in all patients undergoing 7 common elective upper extremity procedures between January 2008 and December 2018: carpal tunnel release, distal radius open reduction and internal fixation (ORIF), trigger finger release, thumb carpometacarpal arthroplasty, phalanx closed reduction and percutaneous pinning, cubital tunnel release, and olecranon ORIF. The medical record was reviewed to determine the impact of surgical assistants (resident, fellow, or physician assistant) on periprocedural outcomes, periprocedural costs, and 1-year postoperative outcomes. The involvement of surgical trainees operating under direct supervision was compared with the entire operation performed by the attending surgeon with a physician assistant present.RESULTS: A total of 396 procedures met the inclusion criteria. Analysis of the whole study sample revealed low rates of intraoperative complications, wound complications, medical complications, readmissions, and mortality. Subgroup analysis of carpal tunnel releases revealed significantly greater tourniquet times for residents compared with physician assistants (7 ± 2 min, 6 ± 1 min), as well as longer overall operating room times for residents compared to fellows or physician assistants (17 ± 5 min, 13 ± 3 min, 12 ± 3 min). Operating room times for distal radius ORIF were significantly greater among residents compared to fellows or physician assistants (68 ± 19 min, 57 ± 17 min, 56 ± 14 min). There were no differences in any other perioperative metrics or periprocedural costs for the trigger finger release or cubital tunnel release cohorts.CONCLUSIONS: Resident involvement in select upper extremity procedures can lengthen operative times but does not have an impact on blood loss or operating room costs.CLINICAL RELEVANCE: Surgeons should be aware that having a resident assistant slightly increases operative times in elective hand surgery.
KW - Hand surgery
KW - orthopedic resident
KW - outcomes
KW - surgical education
UR - http://www.scopus.com/inward/record.url?scp=85128589366&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2022.02.006
DO - 10.1016/j.jhsa.2022.02.006
M3 - Article
C2 - 35461739
SN - 0363-5023
VL - 48
SP - 788
EP - 795
JO - Journal of Hand Surgery (Am)
JF - Journal of Hand Surgery (Am)
IS - 8
ER -