Is Resident Participation Associated With Complications in Isolated Maxillofacial Fracture Repair?

BACKGROUND

Resident participation in surgery has been associated with longer operative times, but its impact on clinical outcomes is mixed. While this relationship has been explored in other surgical subspecialties, it remains understudied in maxillofacial trauma--a core component of oral and maxillofacial surgery training.

PURPOSE: The purpose of this study was to measure the association between resident participation and perioperative outcomes in patients undergoing open reduction and internal fixation of a single maxillofacial fracture.

STUDY DESIGN, SETTING, SAMPLE: This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database, 2005-2012. Patients undergoing open reduction and internal fixation of a single maxillofacial fracture were included. Patients under 18 years old or with missing data were excluded.

PREDICTOR VARIABLE: The predictor was resident participation in the surgical case (yes/no).

MAIN OUTCOME VARIABLE: The primary outcome was the presence of any complication within 30 days postoperatively. Secondary outcomes included operative time (minutes), return to the operating room, and presence of any surgical complication.

COVARIATES: Covariates were categorized as demographic (age, sex), medical (body mass index, comorbidities) and operative (wound classification, fracture location).

ANALYSES: Descriptive and bivariate statistics were calculated. Relative risks and 95% CIs were computed to measure the association between resident participation and complications.

RESULTS

There were 746 subjects with a mean age of 38.5 ± 16.7 years (79.2% male, n = 591). Of these subjects, 454 (60.9%) underwent surgery with resident participation and 292 (39.1%) without. The overall complication rate was 3.6% (n = 27), with no significant difference between cases with (4.4%, n = 20) and without (2.4%, n = 7) residents (relative risk 1.84; 95% CI 0.82-4.64; P = .1). Resident involvement was not associated with increased surgical complications or return to the operating room. Mean operative time was 45% longer with resident participation (136 vs 94 minutes, P < .001).

CONCLUSION AND RELEVANCE: Resident participation was not associated with higher complication rates, but was associated with longer operative time. These findings support the continued role of surgical trainees while identifying opportunities to improve operative efficiency in academic settings.