Presence of orthopedic trainee does not impact patient-reported outcomes in spine surgery
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Presence of a fellow or resident has no effect on patient-reported outcomes, surgery time, length of stay, readmission, infection or revision in patients who have lumbar spinal fusion surgery, according to recently published data.
Srikanth N. Divi, MD, and colleagues at Rothman Orthopaedic Institute retrospectively analyzed data on 172 patients who underwent 1 to 3 level lumbar spine fusion with a fellow or resident as the primary assist and a matched cohort of 178 patients who underwent the procedure with a physician’s assistant (PA) as the primary assist. According to the study, patient-reported outcome measures (PROMs) were collected at minimum 1-year follow-up, including Short Form-12 Physical and Mental Component Scores, Oswestry Disability Index (ODI) and VAS pain scale. Additional outcomes included surgical time, length of stay (LOS), revision, infection and 30- or 90-day readmission rates.
Overall, patients in the PA group had larger improvements in ODI compared with patients in the fellow/resident group; however, after multiple linear regression, Divi and colleagues found no differences in total surgical time, LOS, revision, infection or readmission rates between the fellow/resident and the PA groups. Similarly, after multiple binary logistic regression, the researchers found the presence of a fellow/resident was not a significant predictor of PROMs.
“While the impact of trainee involvement in other surgical fields is well established, there is a paucity of literature assessing this relationship in orthopedic spine surgery,” the researchers wrote in the study. “Multivariate analysis showed that the presence of a surgical trainee was not an independent predictor of any PROM or any complication, even when adjusting for baseline differences. In addition, despite operating on patients with significantly more medical comorbidities, [fellow/residents] had a similar total surgery time and LOS compared with PAs as first assists.”
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