School of Medicine and Health Sciences Poster Presentations

Title

The Effect of PGY Status on Rates of Postoperative Complications in All Orthopedic Surgeries – A study on the National Surgical Quality Improvement Project Database

Poster Number

327

Document Type

Poster

Status

Medical Student

Abstract Category

Quality Improvement

Keywords

Orthopedic surgery, resident participation, complication rate

Publication Date

Spring 2018

Abstract

Background: The influence of residents’ participation on patient morbidity has been thoroughly studied across all specialties in the field of medicine. The focus of these studies was on residents as a whole relative to a control (i.e. attending only). The present study assessed the influence of resident involvement on patient morbidity, but stratified the data among residents based on level of experience.

Methods: The present study utilized the 2005-2014 NSQIP dataset to assess rate of complications in 36,020 patients after all orthopedic surgeries between two tiers of residents by PGY status. Only residents with PGY value of 1-6 were included in the study. Orthopedic training was separated into two groups: PGY 1-3 and PGY 4-6, signifying first and second half of orthopedic surgery training.

Results: Univariate analysis for operative complications showed higher rate of organ space infection in PGY 4-6 group (0.4% vs. 0.3%, p-value: 0.042). Once controlling for comorbidities on multivariate analysis, these differences disappeared (p-value: 0.111). On univariate analysis for non-operative complications, PGY 4-6 group had higher rates of pulmonary embolism (0.5% vs. 0.3%, p-value: 0.006), requiring transfusion (9.0% vs. 7.7%, pvalue: <0.001), and myocardial infarction (0.4% vs. 0.2%, p-value: 0.009). On multivariate analysis, pulmonary embolism (Odds ratio: 1.74, p-value: 0.004), post-operative transfusions (Odds ratio: 1.12, p-value: 0.007), and myocardial infarction (Odds ratio: 2.35, pvalue: 0.001) were shown to be higher in the more experienced residents, even after controlling for pre-operative comorbidities.

Conclusion: We found no significant difference between inexperienced residents (PGY 1-3) and more experienced residents (PGY 4-6) in rates of operative complications. However, it was found that there is a greater risk of non-operative complications in the group of more experienced residents, signifying a discrepancy exists in medical management post-operatively as orthopedic residents advance through training.

Level of Evidence: Level II Retrospective Cohort Study

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The Effect of PGY Status on Rates of Postoperative Complications in All Orthopedic Surgeries – A study on the National Surgical Quality Improvement Project Database

Background: The influence of residents’ participation on patient morbidity has been thoroughly studied across all specialties in the field of medicine. The focus of these studies was on residents as a whole relative to a control (i.e. attending only). The present study assessed the influence of resident involvement on patient morbidity, but stratified the data among residents based on level of experience.

Methods: The present study utilized the 2005-2014 NSQIP dataset to assess rate of complications in 36,020 patients after all orthopedic surgeries between two tiers of residents by PGY status. Only residents with PGY value of 1-6 were included in the study. Orthopedic training was separated into two groups: PGY 1-3 and PGY 4-6, signifying first and second half of orthopedic surgery training.

Results: Univariate analysis for operative complications showed higher rate of organ space infection in PGY 4-6 group (0.4% vs. 0.3%, p-value: 0.042). Once controlling for comorbidities on multivariate analysis, these differences disappeared (p-value: 0.111). On univariate analysis for non-operative complications, PGY 4-6 group had higher rates of pulmonary embolism (0.5% vs. 0.3%, p-value: 0.006), requiring transfusion (9.0% vs. 7.7%, pvalue: <0.001), and myocardial infarction (0.4% vs. 0.2%, p-value: 0.009). On multivariate analysis, pulmonary embolism (Odds ratio: 1.74, p-value: 0.004), post-operative transfusions (Odds ratio: 1.12, p-value: 0.007), and myocardial infarction (Odds ratio: 2.35, pvalue: 0.001) were shown to be higher in the more experienced residents, even after controlling for pre-operative comorbidities.

Conclusion: We found no significant difference between inexperienced residents (PGY 1-3) and more experienced residents (PGY 4-6) in rates of operative complications. However, it was found that there is a greater risk of non-operative complications in the group of more experienced residents, signifying a discrepancy exists in medical management post-operatively as orthopedic residents advance through training.

Level of Evidence: Level II Retrospective Cohort Study