Evaluation Of The Impact Of Residents' Participation On Free Flap Reconstruction
Efstathios Karamanos, MD, Husain Al-Qattan, MD, Noah Saad, MD, Howard Wang, MD.
UT Health San Antonio, San Antonio, TX, USA.
PURPOSE: Microsurgical reconstruction training is an integral part of plastic and reconstructive surgery that has seen a significant increase in its popularity and utilization. The aim of this study was to assess the impact of residents' involvement on outcomes in free flap reconstruction using a large national database.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all free flap reconstruction performed in 2011 - 2012 using the appropriate CPT codes. Primary outcome was post operative wound complications. Secondary outcomes included readmission, reoperation, hospital length of stay and total operative time. Multivariate regression models were used to assess the impact of resident involvement and resident experience on outcomes.
RESULTS: A total of 461 cases were identified. Out of those, 92 cases were performed by a attending alone while the rest were performed by residents and attendings. Cases performed by attendings alone were less likely to result in wound complications [8.4% versus 4.3%, [AOR (95% CI): 0.24 (0.07, 0.88), adj - p = 0.031]. Increasing PGY level had a protective impact on wound complications [0.86 (0.74, 0.99), adj = p = 0.044]. Similarly, cases performed by attendings alone were less likely to result in readmission [4.1% versus 3.3%, 0.20 (0.04, 0.96), adj - p = 0.045] and re - operations [8.1% versus 2.2%, 0.06 (0.01, 0.30) , adj - p = 0.001].
CONCLUSION: Resident participation in free flap reconstruction was associated with an increased overall complication rate, however increasing PGY level decreased the probability of developing adverse outcomes. The above findings need to be carefully weighed with the objectives of residency training in order to achieve adequate resident education while optimizing the patients' outcomes.
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