Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty
Background: Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs). M...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344122000681 |
| _version_ | 1818252617686450176 |
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| author | Aditya V. Maheshwari, MD Christopher T. Garnett, BA Tzu H. Cheng, MD Joshua R. Buksbaum, BS Vivek Singh, MD, MPH Neil V. Shah, MD, MS |
| author_facet | Aditya V. Maheshwari, MD Christopher T. Garnett, BA Tzu H. Cheng, MD Joshua R. Buksbaum, BS Vivek Singh, MD, MPH Neil V. Shah, MD, MS |
| author_sort | Aditya V. Maheshwari, MD |
| collection | DOAJ |
| description | Background: Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs). Material and methods: Fifty patients undergoing single-staged sequential bilateral primary TKAs were evaluated. The more symptomatic side was performed by the attending surgeon first, followed by the contralateral side performed by a chief resident under direct supervision and assistance of the same attending surgeon. Surgery was subdivided into 8 critical steps on both sides. The overall time and critical stepwise surgical time and short-term clinical outcomes were then compared between the 2 sides. Results: The attending surgeon completed the surgery (skin incision to dressing) significantly faster than the resident (70.2 vs 96.9 minutes) by a mean of 26.7 minutes (P < .05) and was also faster in all steps. The most significant differences in time were in “exposure” (9.5 vs 16.5 minutes) and “closure” steps (13.2 vs 24.9 minites), all P < .001. Adverse events occurred in 7 patients; 5 of these resolved uneventfully. There were no significant differences in surgical complications, objective outcome scores, or patient satisfaction scores between both sides. Conclusion: Resident participation in TKA increased operative time without jeopardizing short-term patient clinical outcomes, satisfaction, and complications. This may alleviate concerns from patients and policymakers about TKA in an academic setting. Surgical “exposure” and “closure” were the most prolonged steps for the residents, and they may benefit with more focus and/or simulation studies during training. |
| first_indexed | 2024-12-12T16:27:02Z |
| format | Article |
| id | doaj.art-a71b75a145244dcaa9c81aa324f085fa |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-12T16:27:02Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-a71b75a145244dcaa9c81aa324f085fa2022-12-22T00:18:51ZengElsevierArthroplasty Today2352-34412022-06-0115202209.e4Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee ArthroplastyAditya V. Maheshwari, MD0Christopher T. Garnett, BA1Tzu H. Cheng, MD2Joshua R. Buksbaum, BS3Vivek Singh, MD, MPH4Neil V. Shah, MD, MS5Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA; Corresponding author. SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY 11203, USA.Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA; Department of Anesthesiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USABackground: Although several studies have indirectly compared teaching and nonteaching hospitals, results are conflicting, and evaluation of the direct impact of trainee involvement is lacking. We investigated the direct impact of resident participation in primary total knee arthroplasties (TKAs). Material and methods: Fifty patients undergoing single-staged sequential bilateral primary TKAs were evaluated. The more symptomatic side was performed by the attending surgeon first, followed by the contralateral side performed by a chief resident under direct supervision and assistance of the same attending surgeon. Surgery was subdivided into 8 critical steps on both sides. The overall time and critical stepwise surgical time and short-term clinical outcomes were then compared between the 2 sides. Results: The attending surgeon completed the surgery (skin incision to dressing) significantly faster than the resident (70.2 vs 96.9 minutes) by a mean of 26.7 minutes (P < .05) and was also faster in all steps. The most significant differences in time were in “exposure” (9.5 vs 16.5 minutes) and “closure” steps (13.2 vs 24.9 minites), all P < .001. Adverse events occurred in 7 patients; 5 of these resolved uneventfully. There were no significant differences in surgical complications, objective outcome scores, or patient satisfaction scores between both sides. Conclusion: Resident participation in TKA increased operative time without jeopardizing short-term patient clinical outcomes, satisfaction, and complications. This may alleviate concerns from patients and policymakers about TKA in an academic setting. Surgical “exposure” and “closure” were the most prolonged steps for the residents, and they may benefit with more focus and/or simulation studies during training.http://www.sciencedirect.com/science/article/pii/S2352344122000681Residency trainingResident educationTotal knee arthroplastySingle-staged bilateralPostoperative outcomesOrthopaedic surgery |
| spellingShingle | Aditya V. Maheshwari, MD Christopher T. Garnett, BA Tzu H. Cheng, MD Joshua R. Buksbaum, BS Vivek Singh, MD, MPH Neil V. Shah, MD, MS Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty Arthroplasty Today Residency training Resident education Total knee arthroplasty Single-staged bilateral Postoperative outcomes Orthopaedic surgery |
| title | Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty |
| title_full | Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty |
| title_fullStr | Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty |
| title_full_unstemmed | Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty |
| title_short | Does Resident Participation Influence Surgical Time and Clinical Outcomes? An Analysis on Primary Bilateral Single-Staged Sequential Total Knee Arthroplasty |
| title_sort | does resident participation influence surgical time and clinical outcomes an analysis on primary bilateral single staged sequential total knee arthroplasty |
| topic | Residency training Resident education Total knee arthroplasty Single-staged bilateral Postoperative outcomes Orthopaedic surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2352344122000681 |
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