Division of Plastic Surgery, Yale School of Medicine, New Haven.
Division of Orthodontics, University of Connecticut, Farmington, CT.
J Craniofac Surg. 2022;33(1):125-128. doi: 10.1097/SCS.0000000000008104.
Within the academic surgical setting resident involvement may confer longer operative times. The increasing pressures to maximize clinical productivity and decreasing reimbursement rates, however, may conflict with these principles. This study calculates the opportunity cost of resident involvement in craniofacial surgery.
Retrospective analysis was conducted with patients who underwent craniofacial procedures from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Patients were selected based on relevant Current Procedural Terminology codes for craniofacial pathologies (ie, trauma, head and neck reconstruction, orthognathic surgery, and facial reanimation). Variables included patient demographics, operative time, and presence or absence of resident trainee. Average relative value units were calculated to determine the opportunity cost of resident involvement for each craniofacial procedure.
In total, 2096 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Resident involvement was associated with a statistically significant higher operative time (P < 0.001) for facial reanimation, facial trauma, orthognathic surgery, and head and neck reconstruction. The opportunity costs per case associated with resident involvement were the highest for head and neck reconstruction ($1468.04), followed by orthognathic surgery ($1247.03), facial trauma ($533.03), and facial reanimation ($358.32). Resident involvement was associated with higher rate of complications for head and neck reconstruction (P < 0.043).
Resident involvement is associated with longer operative times, higher complications, and higher re-operations, compared to attending exclusive surgical care. Future studies may consider how reimbursements should align incentives to promote resident education and training.
在学术外科环境中，住院医师的参与可能会导致手术时间延长。然而，为了最大限度地提高临床生产力和降低报销率，这些原则可能会产生冲突。本研究计算了住院医师参与颅面外科手术的机会成本。
回顾性分析了 2005 年至 2012 年期间美国外科医师学院国家手术质量改进计划数据库中接受颅面手术的患者。根据颅面病变的相关当前程序术语 (即创伤、头颈部重建、正颌手术和面部再运动) 选择患者。变量包括患者人口统计学数据、手术时间以及住院医师实习生的存在或不存在。计算平均相对价值单位，以确定每个颅面手术住院医师参与的机会成本。
总共从 2005 年至 2012 年的美国外科医师学院国家手术质量改进计划数据库中确定了 2096 例患者。住院医师的参与与面部再运动、面部创伤、正颌手术和头颈部重建的手术时间显著延长相关 (P ＜ 0.001)。与住院医师参与相关的每例病例的机会成本最高的是头颈部重建 ($1468.04)，其次是正颌手术 ($1247.03)、面部创伤 ($533.03) 和面部再运动 ($358.32)。与住院医师参与相关的头颈部重建并发症发生率更高 (P ＜ 0.043)。
与仅由主治医生进行手术相比，住院医师的参与与手术时间延长、并发症增加以及再次手术率增加相关。未来的研究可能会考虑如何调整报销以激励住院医师的教育和培训。
