The Impact of Resident Post Graduate Year Involvement in Body Contouring Procedures: A Comprehensive Analysis of 9,638 Patients

Background

Plastic surgery programs have emphasized the importance of ensuring patient safety while providing residents with a complete training experience. Residents have noted aesthetic procedures being the ones they are most uncomfortable in performing during and after training. Given the rising popularity in body contouring procedures in the United States, the impact of resident involvement in these procedures were assessed. Notably, the association between resident involvement and post-operative complications remains largely unknown. As such, the aim of this study was to evaluate the impact of resident involvement on outcomes of body contouring procedures.

 

Methods

A retrospective analysis of the National Surgical Quality Improvement Program database was performed (2006–2012) to identify patients undergoing body contouring procedures, using Current Procedural Terminology codes. Outcome measures included: postoperative complications, reoperation, readmission, operative time and hospital length of stay. Multivariate regression models were used to assess the impact of resident involvement and resident experience on outcomes. 

 

Results

A total of 9,638 cases were identified, of which 3,311 involved resident participation. Body contouring patients in resident involvement vs. non-resident involvement groups were significantly older (46.2 vs. 45.5 years, p=0.011), had greater body mass index (BMI) (31.0 vs. 30.6 kg/m², p=0.004), had higher incidence of diabetes (6.9% vs. 4.8%, p<0.001), were more often operated on in an inpatient setting (31.9% vs. 17.7%, p<0.001), and were more often in American Society of Anesthesiologist (ASA) classification III or IV (17.9% vs. 12.6%, p<0.001). After adjusting for confounders, resident involvement was associated with significantly higher overall complications (7.8% vs. 4.4%, p=0.003), surgical site complication rates (5.5% vs. 3.3%, p=0.019), thromboembolic events (0.7% vs. 0.4%, p=0.042), and longer operative time (180.7 vs. 171.9 minutes, p=0.005). There was a significant decrease in odds of overall complications (odds ratio (OR): 0.906; p=0.013) and thromboembolic complications (OR: 0.780; p=0.022) when looking into the impact of resident experience per year increase of post-graduate year (PGY).

 

Conclusions

Resident involvement in body contouring procedures was associated with an increased rate of overall complications in a large, national database. However, the clinical significance of these outcomes may be debated. Increased post graduate year experience as a surgical resident was inversely associated with overall complications. Guided resident autonomy and earlier exposure to body contouring procedures could lead to an optimization of clinical outcomes and resident education.