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Resident and Fellow Participation in Thyroid and Parathyroid Surgery: An American College of Surgeons NSQIP Clinical Outcomes Analysis
*Timothy Feeney, *Lori Lyn Price, *Lilian Chen, Roger Graham, *Abhishek Chatterjee
Tufts Medical Center, Boston, MA
Objective:
We aimed to identify potential differences in patient outcomes in thyroid and parathyroid surgeries performed with surgical trainees at different levels of training.
Design:
This study is a retrospective database analysis using the ACS National Surgical Quality Improvement Project (NSQIP) database. Results spanning from 2005 through 2013 were examined. The top three most frequent thyroid and parathyroid CPT codes were evaluated: parathyroidectomy (60500), thyroidectomy (60240), and thyroid lobectomy (60220). Odds-ratios were calculated comparing the complication rates between attending-only cases and cases involving trainees. Power calculations were performed and there is > 99% power to detect a primary outcome difference of > 1%.
Setting:
The study included cases from the NSQIP database, which is an aggregate of data from participating facilities including academic, non academic, community and tertiary centers.
Patients:
All patients included in this study were de-identified and the data acquired from the NSQIP database. The records of 84,770 cases were selected based on CPT code.
Interventions:
No interventions.
Main Outcome Measures:
Primary outcome measure was overall post-surgical complication rate in attending-only versus attending plus trainee groups.
Results:
Odds ratios and 95% CIs for overall complications were calculated with the attending-only cases without a surgical trainee as the reference. In cases that included a junior trainee (PGY1-2) the OR was 1.00 (0.81, 1.23), p=0.99; for cases that included a senior trainee (PGY3-5) the OR was 0.97 (0.86, 1.09), p=0.64; and for cases that included a fellow the OR was 0.96 (0.72, 1.27), p=0.67.
Conclusions:
Trainee involvement in frequently performed thyroid and parathyroid surgeries is not significantly associated with an increase in complications. Additionally, we found nothing to suggest level of trainee affected overall complications.
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