Resident Involvement in Hand Surgery Does Not Impact Operative Efficiency or Short-Term Postoperative Complications: A Propensity-Matched Study.

OBJECTIVE: In the academic training environment, hand surgeons are tasked with the challenge of teaching operative skills to trainees and balancing efficiency with more complex surgical procedures. In light of a lack of evaluation regarding resident involvement during common hand surgical procedures, we sought to evaluate whether resident involvement in hand surgery cases affects postoperative complication rates and efficiency.

DESIGN: Retrospective, matched case-control study evaluating patient demographics, comorbidities, operative times, lengths of stay (LOS), and short term (30-day) postoperative complications for hand surgery cases involving a resident assistant versus surgeon only.

SETTING: Nationwide evaluation of surgeons and residents who assisted during carpometacarpal (CMC) arthroplasty for basal joint arthritis and distal radius fracture open reduction and internal fixation (ORIF).

PARTICIPANTS: In total, 1752 cases (50% with resident involvement) were included.

RESULTS: Overall, 602 patients underwent CMC arthroplasty and 1150 underwent distal radius fracture ORIF, with no difference in demographic or health characteristics between resident only cases versus surgeon only cases. The overall rate of adverse events after hand surgery was 3.25% (57/1752). There were no significant differences in the short-term complication rates in resident-involved (2.5%) versus attending only group (4.0%) (p = 0.105). Total operative times were similar between cohorts (75.8 min versus 74.2 min) (p = 0.563). Lengths of stay were similar between attending only cases and resident involved cases (0.2 vs 0.3 days (p = 0.743). After controlling for patient comorbidities and surgery, resident involvement was not associated with increased odds of postoperative complications.

DISCUSSION: Resident involvement in hand surgery is not associated with increased risk for short term (30 day) medical or surgical postoperative complications. Operative efficiency was not impacted by resident involvement during common hand surgery procedures.

LEVEL OF EVIDENCE: III.