Results published in the Journal of Bone and Joint Surgery showed no association between resident participation in treatment of intertrochanteric hip fractures and an increase in morbidity or mortality. However, researchers did identify an increase in time-related secondary outcome measures.
Samir Mehta, MD, and colleagues queried the National Surgical Quality Improvement Program database for intertrochanteric hip fractures treated with either extramedullary or intramedullary fixation from 2010 to 2013. They extracted demographic variables, including resident participation, as well as primary and secondary outcome variables for analysis.
Primary outcome measures included death and serious morbidity, while secondary outcome variables included incidence of specific complications, total operative time, total length of hospital stay, time from admission to the OR and time from the operation to hospital discharge.
Overall, 1,764 cases had data available on resident participation. Between the groups with and without resident participation, researchers found no significant differences in 30-day mortality or serious morbidity for all intertrochanteric hip fractures, according to results of a univariate analysis. Similar results were identified through multivariate and propensity score-matched analyses. When a prolonged case was defined as one above the 90th percentile for time parameters, results showed an association between resident involvement and prolonged OR time, length of stay and time to discharge.
“The study revealed that resident participation in hip fracture surgery did increase time-based metrics — like operative time — but had no impact on morbidity or mortality. It was safe to allow residents to participate in the operative management of patients with hip fractures,” Mehta told Healio.com/Orthopedics. “This is consistent with previous studies that have been done looking at other procedures. There is an increased cost to the health care system in having residents participate in care, but their involvement does not lead to worse outcomes. As such, CMS should recognize the increased burden of surgical training on the health system. This burden is a necessity to continue to provide a high level of care for generations to come.” – by Casey Tingle
Disclosures: Mehta reports he receives grants from the U.S. Department of Defense, Synthes and the Foundation of Orthopaedic Trauma; and personal fees from Synthes, Smith & Nephew and Bioventus. Please see the full study for a list of all other authors’ relevant financial disclosures.