Impact of surgical experience on outcomes in total joint arthroplasties

Abstract

Background: Outcomes of primary total hip and knee arthroplasties performed by consultant surgeons were compared with those performed by orthopaedic trainees. Furthermore, outcomes of these procedures performed by senior trainees were compared with those performed by junior trainees.

Methods: Data from the St Vincent's Melbourne Arthroplasty Outcomes Registry and the surgical log kept by trainees were reviewed to investigate if an association exists between surgical experience and clinical outcomes following primary total hip and knee arthroplasties. Multivariate logistic regression analyses were conducted to produce odds ratios with 95% confidence intervals to assess these relationships.

Results: Arthroplasties performed by trainees were not significantly different from those performed by consultant surgeons in regards to medical, surgical and wound complications. Trainee-performed primary total hip arthroplasties were associated with a 30% increase in the risk of requiring a transfusion compared with consultant cases. Primary total knee arthroplasties performed by junior trainees were associated with a 50% increase in the risk of developing a wound complication compared with those performed by senior trainees.

Conclusions: Overall, senior orthopaedic trainees working independently and junior orthopaedic trainees under supervision as the primary surgeon have the ability to achieve a level of clinical outcomes similar to a consultant surgeon. Junior trainees with supervision have the ability to achieve a level of clinical outcomes similar to senior trainees. These findings can be used to further improve orthopaedic training to reduce adverse events during supervised surgery.

Keywords: arthroplasty; competency; education; orthopaedics; outcomes.