The Impact of Resident Participation on Surgical Efficiency and Outcomes in Plastic Surgery
Kelli Aibel, GED1, Jared Blau, BS1, Andrew Atia, BS1, Rachel Hein, MD1, Scott T. Hollenbeck, MD2.
1Duke University, Durham, NC, USA, 2Duke University Medical Center, Durham, NC, USA.
Purpose: Our goal is to evaluate the growing pressures for surgeons to 1) be efficient 2) decrease complications and 3) teach residents.
Methods: The ACS NSQIP database was queried to identify 5 isolated surgical procedures by CPT code. These were muscle flap trunk (MFT), abdominoplasty (AbP), unilateral breast tissue expander +/- dermal substitute (UTE), unilateral breast reconstruction with abdominal free flap (UBrFF) and bilateral breast reduction (BBR). Cases were categorized based on presence or absence of a resident. Means and proportions were compared using the T-test with p<0.05 representing a significance.
Results: A total of 1913 cases met inclusion criteria. Patient demographics did not significantly differ in 22 of the 25 parameters tested (Table1A). For MFT and UBrFF, operative times were significantly longer for cases performed with residents (Table1B). For AbP and UTE there was no significant difference in operative times based on resident participation (Table1B). For BBR the operative times were significantly shorter for cases performed with resident participation (Table1B). The rate of complications did not differ based on resident participation in 4 of the 5 selected cases (Table1B).
Conclusion: For complicated cases, resident involvement is associated with longer operative times. For basic procedures resident involvement is not associated with longer operative times. The concept of valued resident education in opposition with surgical efficiency and safety requires discussion in order to optimize conflicting interests.
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