129. Presence of a surgical trainee does not affect patient outcomes in lumbar fusion surgery

Abstract

BACKGROUND CONTEXT Lumbar decompression and fusion surgery is a common orthopedic procedure and a key component in surgical training for both orthopedic spine surgery fellows and orthopedic surgery residents. While the impact of trainee involvement in other fields is well established, there is a paucity of literature assessing this relationship in spine surgery. PURPOSE To determine whether the presence of a fellow or resident (F/R) compared to a physician assistant (PA) affected surgical characteristics or short-term patient outcomes. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Three hundred and fifty patients who underwent a 1-3 level lumbar spine fusion with 1-5 levels of decompression at a high-volume academic center were retrospectively identified. Patients were divided into two groups based on whether an orthopedic spine fellow or resident was involved in the surgical case compared to a physician assistant. OUTCOME MEASURES Total surgery duration, length of stay, 30-day and 90-day readmissions, infection and revision rates, patient-reported outcome measures (SF-12 PCS and MCS, ODI, VAS Back, VAS Leg). METHODS Operative reports from all cases were examined and patients were placed into the F/R or PA group based on whether a trainee or PA was assisting the attending surgeon. Patients with less than one-year follow-up were excluded. Univariate analysis was used to compare differences between groups. Multiple linear regression was used to assess change in each patient reported outcome and multiple binary logistic regression was used to determine significant predictors of revision, infection, and 30- or 90-day readmission. RESULTS One hundred and seventy-two patients were included in the F/R group compared to 178 patients in the PA group. There were no baseline differences in age, sex, BMI, smoking status, follow-up, preoperative diagnosis, number of levels decompressed and fused, or surgery type. Patients in the F/R group had a significantly higher age-adjusted Charlson Comorbidity Index (aCCI), 3.40 [3.07, 3.74] vs. 2.69 [2.39, 3.00], p = 0.002. There were no differences between groups for total surgery time, length of stay, 30-day or 90-day readmissions, infection or revision rates. On univariate analysis of patient-reported outcomes, there were no differences between groups pre- or postoperatively. Using multiple linear regression analysis, presence of a surgical trainee did not significantly influence any patient reported outcome. Multiple logistic regression analysis also showed that presence of a surgical trainee did not affect infection, revision, or 30- and 90-day readmission rates. CONCLUSIONS Despite operating on patients with significantly more comorbidities, the results of this study show that the presence of an orthopedic spine fellow or orthopedic surgery resident does not increase complication rates and does not affect short-term patient-reported outcomes in lumbar decompression and fusion surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.