Does Surgeon Experience Affect the Risk of Post-Op Complications for Patients Undergoing Fixation for Intertrochanteric Fractures

Abstract

Background: Intertrochanteric fractures compromise approximately one half of all hip fractures. Common complications following fixation of these fractures include cut-out, non-union and avascular necrosis (AVN). It is unclear what effect surgeon experience has on the risk of developing these complications following fracture fixation. The purpose of this study was to compare the post-surgical outcomes for patients treated with TFNA nail for intertrochanteric fractures between residents and fellow trained orthopedic surgeons. Methods: Data was retrieved from the medical records of patients that underwent closed reduction and internal fixation (CRIF) for type 31A1, 31A2 and 31A3 (AO classification) fractures of the proximal femur. All of the fractures were treated with the Trochanteric Fixation Nail Advanced (TFN-A) nail between January 2017 and June 2018. Surgery was performed by either a fellowship-trained trauma surgeon or a resident who had completed his third year of residency. Data such as the duration of surgery, decreased hemoglobin levels, together with data on other hospitalization characteristics and any intraoperative and postoperative complications were retrieved from the medical files. Results: The final study population consisted of 100 patients. Forty-nine patients were operated upon by a senior surgeon, while 51 were operated upon by a resident surgeon. No significant difference was noted between cohorts for the duration of surgery (p = 0.66), blood loss (p = 0.13), orthopedic complications (p = 1) or rates of re-operation (p = 0.35). Conclusion: Residents may perform CRIF for intertrochanteric fractures without placing patients at an increased risk for post-surgical complications.