Page 22 - Delaware Medical Journal - May/June 2019
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TABLE 3: Concomitant procedures, curve correction, blood loss, procedure time, postoperative hospital course, and complications within 90 days of surgery for procedures in which the junior attending assisted with and without the involvement of a second surgical assistant
Leading surgeon + junior attending
7 Patients
Leading surgeon + junior attending + 2nd assistant
9 Patients
Number
%
Number
%
P values
Anterior release
0
0
2
22
0.182
ITB implantation
0
0
2
22
0.182
ITB catheter replacement
4
57
1
11
0.049
Hip plate removal
0
0
0
0
>0.99
Partial coccygectomy
0
0
1
11
0.363
Mean
SD
Mean
SD
P values
Curve correction (%)
-79
10
-74
10
0.341
Blood loss (mL)
2200
876
2256
1209
0.916
Procedure time (minutes)
228
52
260
56
0.247
Intubation (days)
1
1
1
1
0.536
ICU stay (days)
5
8
4
4
0.778
Hospital stay (days)
16
9
16
9
0.963
Number
%
Number
%
P values
Complications
0
0
0
0
>0.99
ICU: intensive care unit, ITB: intrathecal baclofen, SD: standard deviation
involved patients,14 the involvement of
a team dedicated to medically complex patients is ideal for such procedures.14
In our study, shorter operative time, less intraoperative blood loss, and shorter
the cerebral palsy team rather than an orthopaedic fellow/resident who might not be interested in cerebral palsy. on these variables was not clear. A previous report9 blood loss between an assisting fellow and an assisting resident,9 although shorter operating time and greater correction are noted in the fellow group.9 No difference in the complications
or reoperations between the different groups was noted in either our study or
the previous study.9 Therefore, and in
our study and the previous study,9 the
involvement of more experienced and more interested surgical assistants in complicated neuromuscular cases.
Having a second assistant for scoliosis surgery in cerebral palsy patients did not each group in our study (Tables 3 and 4). that involving residents in neuromuscular cases does not compromise patient safety.9
The impact of training surgical residents and fellows on hospital cost has also been investigated.1,15,16 Different
procedures are reported with higher operating room cost when residents were involved.1,15,16 However, this cost analysis is complicated, and it should take many variables other than operating room
cost into consideration. In this study, greater blood loss, longer intubation time, and the presence of two deep wound infections and two reoperations (irrigation and debridement) in the fellow/resident group were considered costly differences. However, and because of the complex nature of cost analysis, our study was not able to report accurate cost results.
Limitations of this study include the retrospective nature, the variable levels of assistants’ experience (in the fellow/ resident group), and the absence of cost
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Del Med J | May/June 2019 | Vol. 91 | No. 3
