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Is Resident Participation Associated With Complications in Isolated Maxillofacial Fracture Repair?
Lang Liang1, Tim T Wang2, Nicholas Wilken3
1DMD Candidate, Harvard School of Dental Medicine, Boston, MA.
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.
Insights
Resident participation in maxillofacial fracture surgery did not increase complications but did lengthen operative time. These findings support surgical training while highlighting efficiency improvements in academic settings.
Area of Science:
- Oral and Maxillofacial Surgery
- Surgical Education
- Trauma Surgery
Background:
- Resident participation in surgery is linked to longer operative times, but its effect on clinical outcomes is debated.
- This relationship is understudied in maxillofacial trauma, a key area of oral and maxillofacial surgery training.
Purpose of the Study:
- To assess the association between resident involvement and perioperative outcomes in open reduction and internal fixation of maxillofacial fractures.
- To determine if resident participation impacts complication rates and operative time.
Main Methods:
- Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2005-2012).
- Included patients undergoing open reduction and internal fixation of a single maxillofacial fracture; excluded those under 18 or with missing data.
- Analyzed resident participation as the predictor variable and 30-day postoperative complications, operative time, and return to operating room as outcomes.
Main Results:
- A total of 746 patients were included; 60.9% had resident participation.
- Overall complication rate was 3.6%, with no significant difference between cases with (4.4%) and without (2.4%) residents (RR 1.84; P = .1).
- Resident participation was not associated with increased complications or return to the OR, but mean operative time was 45% longer (136 vs 94 minutes, P < .001).
Conclusions:
- Resident participation in maxillofacial fracture surgery is not linked to higher complication rates.
- Surgical trainees' involvement is associated with increased operative time, suggesting a need for efficiency improvements in academic settings.
- Findings support the continued role of surgical trainees in patient care.
