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

Area of Science:

• Orthopedic Surgery
• Infection Control
• Surgical Outcomes

Background:

• Assessing the impact of surgical trainees on patient safety is crucial in orthopedic procedures.
• Infection rates, including prosthetic joint infection (PJI) and surgical site infection (SSI), are key indicators of surgical outcomes.

Purpose of the Study:

• To determine if the involvement of surgeons-in-training in primary total knee arthroplasty (TKA) is associated with increased PJI and SSI rates.
• To analyze the relationship between trainee participation and infection risk, considering patient and procedural variables.

Main Methods:

• Retrospective review of 12,664 primary TKAs performed between 2014 and 2017.
• Comparison of infection rates (PJI and SSI) between attending-only and trainee-involved surgical groups.
• Univariate and multivariate analyses were used to adjust for factors like BMI, comorbidities, and operative time.

Main Results:

• Trainee-involved cases had longer operative times (p<0.001).
• Univariate analysis showed a significant difference in PJI incidence (p=0.015) for trainee-involved cases, but not SSI (p=0.840).
• Multivariate analysis revealed no independent association between trainee involvement and PJI (p=0.089) or SSI (p=0.998) after adjusting for confounding factors.

Conclusions:

• Trainee participation in primary TKA does not directly correlate with increased PJI or SSI risk.
• Despite longer operative times and increased complexity in trainee cases, infection risk was not independently elevated.
• Further strategies are needed to mitigate infection risks in complex TKA cases with longer operative times and for patients with comorbidities.