Plastic Surgery Research Council

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Evaluating Resident Participation and the July Effect on Outcomes in Autologous Breast Reconstruction
Winona W. Wu, BA1, Caroline Medin, BA1, Alexandra Bucknor, MBBS, MSc1, Parisa Kamali, MD2, Bernard T. Lee, MD, MPH, MBA1, Samuel J. Lin, MD, MBA1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Radboud University Medical Center, Nijmegen, Netherlands.

PURPOSE: While resident involvement in surgical procedures is critical for training, it may be associated with increased morbidity, particularly early in the academic year - a concept dubbed the “July Effect.” Assessments of such phenomena within the field of plastic surgery have been both limited and inconclusive. We sought to investigate the impact of resident participation and academic quarter on autologous breast reconstruction outcomes.
METHODS: Autologous breast reconstruction cases following mastectomy were gathered from the 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were constructed to investigate the association between resident involvement and the first academic quarter (Q1=July-September) with 30-day morbidity (odds ratios, with 95% confidence intervals). Perioperative complications, operation time, and length of stay (LOS) were also compared.
RESULTS: Overall, 2,527 cases were identified. Cases with residents (n=1467) were not associated with increased 30-day morbidity (OR=1.20; 0.95-1.52) when compared to those without (n=1060), though transfusion (OR=2.08; 1.39-3.13) and return to the operating room (OR=1.46; 1.11-1.93) were more frequently observed in resident cases. Operation time and LOS were greater in cases with resident involvement.
In resident cases, there was decreased morbidity in Q1 (n=343) when compared to later quarters (n=1124)(OR=0.67; 0.48-0.92). Specifically, transfusion (OR=0.52; 0.29-0.95), return to operating room (OR=0.64; 0.41-0.98) and surgical site infection (OR=0.37; 0.18-0.75) occurred less during Q1. No differences in operation time and LOS were observed between these subgroups.
CONCLUSION: Our study reveals that resident involvement in autologous breast reconstruction is not associated with increased morbidity, and offers no evidence for a July Effect. Notably, our results suggest that morbidity is decreased in resident cases performed earlier in the academic year, when there may be more attending oversight.


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