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Evaluating resident involvement and the 'July effect' in parotidectomy
D A Benito1, I Mamidi1, L J Pasick2
1Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Objective:
This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy.
Method:
The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014.
Results:
There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05-0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11-0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters.
Conclusion:
Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.
Insights
Resident involvement in parotidectomy surgery lowers reoperation and readmission rates. The
Area of Science:
- Surgical Outcomes Research
- Head and Neck Surgery
- Medical Education
Background:
- The 'July effect' describes potential increased risks during academic year transitions.
- Evaluating resident involvement in parotidectomy is crucial for patient safety and training.
- Parotidectomy is a complex head and neck surgical procedure.
Purpose of the Study:
- To assess the impact of resident participation on peri-operative complications after parotidectomy.
- To investigate whether the 'July effect' influences outcomes in parotidectomy cases involving residents.
Main Methods:
- Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
- Inclusion of parotidectomy procedures with resident involvement from 2005 to 2014.
- Statistical comparison of outcomes between cases with and without resident participation, and across academic quarters.
Main Results:
- A total of 11,733 parotidectomy cases were analyzed, with 7.9% involving residents.
- Resident involvement was linked to significantly lower reoperation (aOR 0.18) and readmission rates (aOR 0.30).
- Cases with residents had longer operative times (mean 24 min increase) and hospital stays (23.5% increase), but no difference in complication or mortality rates, nor an effect of the 'July effect'.
Conclusions:
- Resident participation in parotidectomy is associated with improved safety outcomes, specifically reduced reoperation and readmission rates.
- Despite longer operative times and hospital stays, resident involvement does not increase overall complication rates.
- The 'July effect' does not appear to pose an increased risk for adverse peri-operative outcomes in parotidectomy procedures.
