Abstract
Background Complications after open reduction internal fixation (ORIF) for distal radius fractures
(DRF) are well documented, but the impact of trainee involvement on postoperative
outcomes has not been studied.
Questions Does trainee involvement affect postoperative complication rates and length of hospital
stay?
Methods The American College of Surgeons National Surgical Quality Improvement Program was
queried from 2006 to 2012 for patients undergoing DRF ORIF. A 1:1 propensity score
matched resident/fellow involved cases to attending-only cases. Demographics, length
of stay, and postoperative complications were compared between the two groups. Logistic
regression was used to evaluate independent predictors of adverse events and to evaluate
cases with and without trainee involvement.
Results Overall, 3,003 patients underwent DRF ORIF from 2006 to 2012. After matching, 1,150
cases (50% with resident/fellow involvement) were included. The overall rate of adverse
events was 4.4% (46/1,050). There were no significant differences in the short-term
complication rate in trainee-involved (2.3%) versus attending-only cases (3.9%) (p = 0.461). For ORIF of DRF, there were no significant differences, between attending-only
cases and resident/fellow-involved cases, with regard to short-term major complications
(p = 0.720) or minor complications (p = 0.374). Length of hospital stay was similar between cohorts (1.22 vs. 0.98 days)
(p = 0.723). On multivariate analysis, trainee involvement was not an independent predictor
of minor, major, or any complication after DRF fixation after controlling for multiple
independent factors (all p > 0.364).
Discussion Trainee participation in DRF ORIF is not associated with increased risk of short-term
(30 days) medical or surgical postoperative complications.
Level of Evidence This is a Level IV case–control study.
Keywords
NSQIP - Resident - Education - Orthopaedics - Complications - distal radius fracture
- training
