Does Resident Involvement Affect Clinical Outcomes and Postoperative Complication Rates in Orthopaedic Sports Medicine Surgery?

Abstract

Background:

The “July effect” suggests increased patient morbidity and mortality during the early academic year due to new resident involvement. Evidence specific to orthopaedic sports medicine is limited.

Purpose:

To evaluate the effect of resident and fellow involvement on postoperative complication rates, surgical time, and patient-reported outcomes (PROs) in anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent primary ACLR or RCR between 2014 and 2022 at a single institution with a minimum 2-year follow-up were analyzed. Outcomes included operative time, postoperative complications within 100 days, and PROs (International Knee Documentation Committee Subjective Knee Form, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, Patient-Reported Outcomes Measurement Information System [PROMIS]–Physical Function, PROMIS–Pain Interference, Marx Activity Rating Scale, and visual analog scale). Trainee involvement was defined by resident or fellow presence in the operating room. Statistical analyses included analysis of variance, t tests, chi-square tests, and linear mixed models (P < .05).

Results:

Of the 3997 cases (2065 RCR, 1932 ACLR), trainees were involved in 1537 RCR and 1529 ACLR cases. ACLR demographic characteristics (age, sex, body mass index [BMI], and smoking status) were similar across all groups (P > .05), whereas RCR patients showed modest significant differences in sex (P = .011), BMI (P = .036), and smoking status (P = .012) but not age (P = .13). Postoperative complication rates were comparable with or without trainees (ACLR, 4.6%, P = .4; RCR, 3.6%, P = .4), although operative time was longer in cases with trainee involvement (ACLR, 97 minutes [no trainee] vs 110 minutes [fellow], 105 minutes [resident], and 112 minutes [both], P < .001; RCR, 91 minutes [no trainee] vs 106 minutes [fellow], 103 minutes [resident], and 117 minutes [both], P < .001). No significant differences in PROs were observed at 2 years.

Conclusion:

Trainee involvement in ACLR and RCR did not increase postoperative complication rates or worsen PROs, despite longer operative times and RCR demographic variations, supporting the safety of trainee participation in sports medicine surgeries.