Saturday, June 20, 2015

Shoulder joint replacement arthroplasty - does resident involvement change the complications?

Does resident involvement have an impact on postoperative complications after total shoulder arthroplasty? An analysis of 1382 cases.

These authors searched American College of Surgeons National Surgical Quality Improvement for all patients who underwent total shoulder arthroplasty between 2005 and 2012. They analyzed 1382 patients who underwent primary total shoulder arthroplasty  (TSA), with matched groups of 691 with and 691 without resident involvement. The overall rate of 30-day complications was 2.60% in TSAs in which a resident was involved compared with 3.91% when no resident was involved (P = .173). Operative time and hospital stay were shorter in cases in which a resident was present (P = .002 and P < .001, respectively). Independent risk factors significantly associated with TSA complications identified by multivariate regression were higher patient age, higher American Society of Anesthesiologists classification, congestive heart failure, insulin-dependent diabetes, and peripheral vascular disease.

Comment: One might wonder, 'if residents are not involved in total shoulder arthroplasty, where will the next generation of shoulder arthroplasty surgeons come from?' We know that shoulder arthroplasty cannot be mastered by practicing with plastic bones or in laboratories with cadavers - it requires 'real world' experience with the wide range of pathologies, bone and soft tissue qualities, and challenges of balancing mobility and stability that can only be gained in the operating room.

Of course there are different approaches to resident involvement from minimal to maximal. In that the attending surgeons are committed to the best possible outcome for their patients, we can trust that they will enable the level of involvement appropriate for each situation. This article provides assurance that overall, the decisions made by the attending surgeons and the actions of the residents do not appear to increase the rate of complications. In our setting, we are convinced that resident and fellow involvement brings to each case an increased breadth of knowledge and additional sets of eyes and brains focused on the welfare of each patient.


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