Does resident involvement impact postoperative outcomes after proximal humerus fractures?

Abstract

Proximal humerus fractures (PHFs) are a prevalent orthopedic injury and often require surgical intervention. These surgeries frequently involve resident participation as part of their training, but the impact of this involvement on surgical outcomes remains unclear. This study evaluates the effect of resident participation on perioperative complications and mortality in PHF surgeries. The National Surgical Quality Improvement Program database was retrospectively analyzed from 2006 to 2012. Data were extracted from inpatient records of patients with a PHF who received open reduction internal fixation, hemiarthroplasty, or total shoulder arthroplasty. Multivariate logistic and linear regression models, controlling for demographics and comorbidities identified through univariate analysis, were performed to examine the effect of resident involvement on each outcome. Complication rates between nonresident and resident cases were also stratified by postgraduate year level of training and analyzed via analysis of variance. Because of multiple statistical comparisons, a Bonferroni correction was used for univariate and multivariate analyses, with statistical significance was set at P < .0011. Among the 2,277 analyzed cases, multivariate analysis revealed that resident involvement was associated with increased postoperative complications, including minor complications. Furthermore, the involvement of a senior resident or fellow was significantly associated with increased minor complications compared with cases involving the attending surgeon alone. While resident involvement is vital for developing surgical skills, this study's findings suggest it is associated with increased postoperative complications in PHF surgeries, particularly minor complications. This association highlights the need for further research to understand the factors contributing to the observed differences in postoperative outcomes.