Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Surgery, University of Missouri Columbia, Columbia, Missouri, USA.
Iowa Orthop J. 2022;42(2):75-81.
Academic teaching institutions perform approximately one third of all orthopedic procedures in the United States. Revision total knee arthroplasty (rTKA) is a complex and challenging procedure that requires expertise and extensive planning, however the impact of resident involvement on outcomes is poorly understood. The aim of the study was to investigate whether resident involvement in rTKA impacts postoperative complication rates, operative time, and length of hospital stay (LOS).
The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent rTKA procedures from 2006-2012 using CPT codes 27486 and 27487. Cases were classified as resident involved or attending only. Demographics, comorbidities, and 30-day postoperative complications were analyzed. Multiple logistic regression analysis was performed to identify independent risk factors for increased 30-day postoperative complications. Wilcoxon rank sum tests were performed to determine the impact of resident involvement on operative time and LOS with significance defined as p<0.05.
In total, 2,396 cases of rTKA were identified, of which 972 (40.6%) involved residents. The two study groups were similar, however the resident involved cohort had more patients with hypertension and ASA class 3 (p=0.02, p=0.04). There was no difference in complications between the cohorts (No Resident vs Resident-involved: 7.0% vs 6.7%, p=0.80). Multivariate analysis identified obesity (OR: 1.81, 95% CI: 1.18-2.79, p=0.01), morbid obesity (OR: 1.66, 95% CI: 1.09-2.57, p=0.02), congestive heart failure (OR: 5.97, 95% CI: 1.19-24.7, p=0.02), and chronic prosthetic joint infection (OR: 3.16, 95% CI: 2.184.56, p<0.01), as independent risk factors for 30-day complications after rTKA. However, resident involvement was not associated with complications within 30-days following rTKA (OR: 0.91, 95% CI: 0.65-1.26, p=0.57). Resident involvement was associated with increased operative time (p<0.001) and LOS (P<0.001).
Resident involvement in rTKA cases is not associated with an increased risk of 30-day postoperative complications. However, resident operative involvement was associated with longer operative time and length of hospital stay. .
学术教学机构在美国完成了大约三分之一的骨科手术。翻修全膝关节置换术（rTKA）是一项复杂且具有挑战性的手术，需要专业知识和广泛的规划，但是住院医师的参与对结果的影响却知之甚少。本研究的目的是探讨住院医师参与 rTKA 是否会影响术后并发症发生率、手术时间和住院时间（LOS）。
使用 CPT 代码 27486 和 27487，从 2006 年至 2012 年，通过美国外科医师学院国家手术质量改进计划登记处查询接受 rTKA 手术的患者。将病例分为住院医师参与和仅主治医生参与。分析了人口统计学，合并症和 30 天术后并发症。进行了多变量逻辑回归分析，以确定 30 天术后并发症增加的独立危险因素。Wilcoxon 秩和检验用于确定住院医师参与对手术时间和 LOS 的影响，以 p<0.05 为显著性。
总共确定了 2396 例 rTKA，其中 972 例（40.6％）涉及住院医师。两组研究对象相似，但是住院医师参与组中高血压和 ASA 分级 3 的患者更多（p=0.02，p=0.04）。两组之间的并发症无差异（无住院医师与住院医师参与：7.0％与 6.7％，p=0.80）。多变量分析确定肥胖（OR：1.81，95％CI：1.18-2.79，p=0.01），病态肥胖（OR：1.66，95％CI：1.09-2.57，p=0.02），充血性心力衰竭（OR：5.97，95％CI：1.19-24.7，p=0.02）和慢性人工关节感染（OR：3.16，95％CI：2.184.56，p<0.01）是 rTKA 后 30 天并发症的独立危险因素。但是，住院医师的参与与 rTKA 后 30 天内的并发症无关（OR：0.91，95％CI：0.65-1.26，p=0.57）。住院医师的参与与手术时间延长（p<0.001）和 LOS 延长（P<0.001）有关。
住院医师参与 rTKA 病例不会增加 30 天术后并发症的风险。但是，住院医师的手术参与与手术时间和住院时间延长有关。
