Ryan S Marder1, Neil V Shah1, Qais Naziri1, Aditya V Maheshwari2. 1. Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA. 2. Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA. Aditya.maheshwari@downstate.edu.
Abstract
PURPOSE: Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS: We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. RESULTS: Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. CONCLUSION: Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion.
PURPOSE: Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. METHODS: We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. RESULTS: Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. CONCLUSION: Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion.
Authors: Sanjeev Dutta; Gary Dunnington; Mark Christopher Blanchard; Bethany Spielman; Debra DaRosa; Raymond J Joehl Journal: J Am Coll Surg Date: 2003-12 Impact factor: 6.113
Authors: R A Cowles; C A Moyer; S S Sonnad; D M Simeone; J A Knol; F E Eckhauser; M W Mulholland; L M Colletti Journal: J Am Coll Surg Date: 2001-07 Impact factor: 6.113
Authors: Andrew J Schoenfeld; Jose A Serrano; Brian R Waterman; Julia O Bader; Philip J Belmont Journal: Arch Orthop Trauma Surg Date: 2013-09-01 Impact factor: 3.067
Authors: Dean C Perfetti; Nipun Sodhi; Anton Khlopas; Assem A Sultan; Suela Lamaj; Matthew R Boylan; Jared M Newman; Qais Naziri; William A Cantrell; Aditya V Maheshwari; Carl B Paulino; Michael A Mont Journal: Surg Technol Int Date: 2017-12-22
Authors: Mike H Bao; Benjamin J Keeney; Wayne E Moschetti; Nicholas G Paddock; David S Jevsevar Journal: Clin Orthop Relat Res Date: 2018-07 Impact factor: 4.176
Authors: N Beattie; J F Maempel; S Roberts; H B Waterson; G Brown; I J Brenkel; P J Walmsley Journal: Ann R Coll Surg Engl Date: 2017-09-15 Impact factor: 1.891
Authors: Markus Weber; Michael Worlicek; Florian Voellner; Michael Woerner; Achim Benditz; Daniela Weber; Joachim Grifka; Tobias Renkawitz Journal: PLoS One Date: 2018-06-01 Impact factor: 3.240