Assessing resident participation and its effect on postoperative complications in intertrochanteric and femoral neck fractures: insights on orthopaedic residency training in the USA-A NSQIP retrospective study.

Abstract

The global incidence of hip fractures continues to rise with an aging population. In the USA, orthopedic residency programs prioritize surgical mentorship to prepare trainees for independent practice. However, the impact of resident involvement on patient outcomes, particularly complications following hip fracture fixation, remains unclear. This study evaluates whether resident participation in intertrochanteric and femoral neck fracture surgical treatments only influences postoperative complication rates. We retrospectively analyzed de-identified data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005 to 2012. A total of 6300 patients who underwent hip fracture fixation were identified using ICD-9-CM codes, after excluding incomplete cases. Patients were divided into two cohorts: procedures performed by attending surgeons alone (AA) and those with resident involvement (AR). Groups were matched using propensity score analysis. Postoperative complications were compared using multivariate logistic regression, adjusting for potential confounders. In the AR group, 45.0% of patients experienced at least one complication, compared to 29.3% in the AA group. The AR group had higher rates of postoperative transfusions and systemic complications, including sepsis. Wound dehiscence and organ space infections were significantly more common in the AR group (P < 0.02). Additionally, the AR group demonstrated longer operation times, extended anesthesia-to-incision intervals, and prolonged hospital stays. When stratified by fracture type, intertrochanteric fractures were associated with significantly higher complication rates compared to femoral neck fractures in the AR group (P < 0.001). Despite these findings, multivariate regression analysis revealed no significant difference in the rate of serious complications; including cardiopulmonary, neurologic, infectious, renal, and mortality events; between groups. Resident involvement in hip fracture fixation is associated with increased overall complication rates, particularly in intertrochanteric fractures, but does not significantly affect the incidence of serious complications. These findings highlight opportunities to improve resident training, particularly in surgical efficiency, patient positioning, hemostasis, closure technique, and perioperative care, to better prepare residents for independent surgical practice.