Does Surgical Trainee Participation Affect Infection Outcomes in Primary Total Knee Arthroplasty?

Autor: Anis HK; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio., Rothfusz CA; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio., Eskildsen SM; Raleigh Orthopaedic, Raleigh, North Carolina., Klika AK; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio., Piuzzi NS; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio. Electronic address: piuzzin@ccf.org., Higuera CA; Department of Orthopaedic Surgery, Cleveland Clinic Foundation Florida, Weston Hospital, Weston, Florida., Molloy RM; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio.
Jazyk: angličtina
Zdroj: Journal of surgical education [J Surg Educ] 2022 Jul-Aug; Vol. 79 (4), pp. 993-999. Date of Electronic Publication: 2022 Mar 14.
DOI: 10.1016/j.jsurg.2022.02.006
Abstrakt: Objective: To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA).
Design: This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume.
Setting: A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017.
Participants: A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated.
Results: Residents and fellows were more likely to participate in cases with longer operative times (p<0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998).
Conclusions: Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.
Competing Interests: Declaration of Competing Interest No conflicts of interest to disclose
(Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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