Page 20 - Delaware Medical Journal - May/June 2019
P. 20
TABLE 2: Concomitant procedures with posterior spinal fusion, curve measurements, blood loss, procedure time, postoperative hospital course, and complications and reoperations within 90 days of surgery
Leading surgeon + junior attending
16 patients
Leading surgeon + fellow/resident
28 patients
Number
%
Number
%
P values
Anterior release
2
13
1
4
0.245
ITB implantation
2
13
2
7
0.522
ITB catheter replacement
5
31
5
18
0.292
Hip plate removal
0
0
3
11
0.165
Partial coccygectomy
1
6
0
0
0.171
Mean
SD
Mean
SD
P values
Preoperative curve magnitude
77
21
78
20
0.865
Postoperative curve magnitude
19
10
19
8
0.927
Curve correction (%)
-76
10
-74
12
0.519
Blood loss (mL)
2231
1043
3225
1387
0.0105
Procedure time (minutes)
246
55
288
42
0.013
Intubation (days)
1
1
3
3
0.0014
ICU stay (days)
5
6
8
8
0.181
Hospital stay (days)
16
8
13
8
0.344
Number
%
Number
%
P values
Complications*
0
0
2
7
0.259
Reoperations*
0
0
2
7
0.259
*The two complications recorded in the fellow/resident group were early wound infections that occurred within 30 days of surgery and necessitated debridement and irrigation.
ICU: intensive care unit, ITB: intrathecal baclofen, SD: standard deviation
surgeon performed 44 posterior spinal fusion procedures for scoliosis in patients with cerebral palsy. In 16 procedures, the junior attending assisted in the surgery and in 28 procedures, either a fellow or
was no difference between the two groups in patients’ gender, age, weight z-score, comorbidities, and GMFCS level (Table 1). Intraoperative data showed no difference in concomitant procedures
and curve correction (P>0.05) between the groups (Table 2). However, longer operative time (288 min vs. 246 min;
P=0.0014) were noted in the fellow/ resident group (Table 2). A second assistant was involved in nine out of 16 was found in blood loss or procedure time between these cases and the cases when the junior attending was the only assistant (Table 3). In the second group, a second cases. No difference was found in blood loss or procedure time between these cases and the cases when a fellow or a resident was the only assistant (Table 4).
DISCUSSION
Educating the next generation of surgeons is essential for the continuation of medical care.4 While efforts are constantly made to improve the
surgical education process, its
impact on surgical outcome has also been investigated to protect patient safety. The wide variety of surgical procedures, and the variations of the skill and experience levels among surgeons, makes it necessary to evaluate the results of different procedures and different surgeons separately. Since spinal fusion is the most extensive surgery for patients with cerebral palsy, and patients who need it are generally the most severely
teaching experience in the operating room, and the junior surgeon had less attending surgeon. In the second group, the leading surgeon was assisted by either a pediatric orthopaedic fellow, or by an orthopaedic resident (postgraduate compared between the two groups. Another comparison was performed within each group based on whether a second assistant was involved. In all cases, the second assistant was either an orthopaedic resident (postgraduate year
Statistically, independent t-test was used to compare continuous data between
the groups and chi-square was used to compare categorical data. SPSS Statistics software (IBM Corporation, Armonk, NY USA) was used, with a level of
RESULTS
Between 2011 and 2015, the leading
116
Del Med J | May/June 2019 | Vol. 91 | No. 3
