The Effect of PGY Status on Rates of Postoperative Complications in All Orthopedic Surgeries – A study on the National Surgical Quality Improvement Project Database

Abstract

Background: The influence of residents’ participation on patient morbidity has been thoroughly studied across all specialties in the field of medicine. The focus of these studies was on residents as a whole relative to a control (i.e. attending only). The present study assessed the influence of resident involvement on patient morbidity, but stratified the data among residents based on level of experience. Methods: The present study utilized the 2005-2014 NSQIP dataset to assess rate of complications in 36,020 patients after all orthopedic surgeries between two tiers of residents by PGY status. Only residents with PGY value of 1-6 were included in the study. Orthopedic training was separated into two groups: PGY 1-3 and PGY 4-6, signifying first and second half of orthopedic surgery training. Results: Univariate analysis for operative complications showed higher rate of organ space infection in PGY 4-6 group (0.4% vs. 0.3%, p-value: 0.042). Once controlling for comorbidities on multivariate analysis, these differences disappeared (p-value: 0.111). On univariate analysis for non-operative complications, PGY 4-6 group had higher rates of pulmonary embolism (0.5% vs. 0.3%, p-value: 0.006), requiring transfusion (9.0% vs. 7.7%, pvalue: \u3c0.001), and myocardial infarction (0.4% vs. 0.2%, p-value: 0.009). On multivariate analysis, pulmonary embolism (Odds ratio: 1.74, p-value: 0.004), post-operative transfusions (Odds ratio: 1.12, p-value: 0.007), and myocardial infarction (Odds ratio: 2.35, pvalue: 0.001) were shown to be higher in the more experienced residents, even after controlling for pre-operative comorbidities. Conclusion: We found no significant difference between inexperienced residents (PGY 1-3) and more experienced residents (PGY 4-6) in rates of operative complications. However, it was found that there is a greater risk of non-operative complications in the group of more experienced residents, signifying a discrepancy exists in medical management post-operatively as orthopedic residents advance through training. Level of Evidence: Level II Retrospective Cohort Stud