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The Association between Resident Involvement and Post-Operative Short Term Surgical Morbidity in Immediate Beast Reconstruction: A NSQIP Study of 24,005 Patients
Mohamad E. Sebai, MBBS, Ricardo J. Bello, MD, MPH, Scott D. Lifchez, MD, Damon S. Cooney, MD, PhD, Gedge D. Rosson, MD, Carisa M. Cooney, MPH.
The Johns Hopkins Hosptial, Baltimore, MD, USA.

Purpose: To assess whether resident involvement (RI) in immediate breast reconstruction (IBR) is associated with increased 30-day surgical morbidity.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing IBR between 2005 and 2012. Preoperative demographics, intraoperative variables, RI in surgery, and 30-day postoperative surgical morbidities were identified. Chi-squared test and multivariable logistic regression were used to estimate the effect of RI on surgical complications.
Results: 24,005 patients underwent IBR (17,840 with RI). Thirty-day surgical morbidity was observed in 5.25% (95% CI:4.92%-5.58%) of cases with RI and 5.12% (95% CI:4.59%-5.58%) of cases without RI. Odds of surgical complications were not statistically different between groups (unadjusted OR:1.03; 95% CI: 0.90-1.17, p=0.690) even after controlling for confounding with multivariable logistic regression (adjusted OR:0.97; 95% CI:0.85-1.11; p=0.652). Subgroup analysis by type of reconstruction showed that RI was not associated with surgical complications in implant-based reconstructions, but was associated with lower odds of surgical complications in autologous reconstructions (OR:0.70; 95% CI: 0.53-0.91; p=0.008). However, operative time and reoperation rates were significantly higher with RI across all types of reconstruction (both p<0.001). Postoperative length of stay was statistically significantly longer with RI in autologous reconstruction (mean=3.94, SD=2.42, versus mean=3.73, SD=1.78, respectively; p=0.015) but not in implant reconstruction (p=0.765).
Conclusion: Although this study found no statistically significant evidence for increased post-operative surgical morbidity in IBR patients for whom residents were involved, RI statistically significantly increased operative time, post-operative length of stay, and reoperation rates.


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