ABSTRACT
Background: Changes in surgical education have caused concern over residents' preparedness for independent practice. As the field of otolaryngology requires such a wide breadth of expertise, ill preparation becomes especially costly. This study explores how the presence and participation of a postgraduate year 3 (PGY3) otolaryngology resident in surgery impacts revision rates and operating time as gauges for the resident competency and indirect training costs. Methods: A retrospective chart analysis of patients who underwent cosmetic plastic surgery at sites for PGY3 otolaryngology residents' facial plastic surgery rotations was conducted. Residents performed one side of bilateral procedures (eg, blepharoplasties) and approximately 50% of midline procedures (eg, rhinoplasties). Chi-squared testing and odds/risk ratios were done to assess the effect of resident involvement on revision rates. Operating time was compared using t tests. Results: When a resident was involved in cosmetic surgery, the revision rate was 22.2% compared with 3.6% without. The likelihood of a future revision surgery was 7.57 times higher when a resident participated in the original operation. Resident involvement was not a statistically significant predictor of exceeding the allotted operating time. Conclusions: The revision rate of cosmetic surgery was much higher when a resident was involved. Otolaryngology residents would benefit from increased facial plastic and reconstructive surgery training. As a response to this analytical study, this clinical rotation was moved to be offered at a later stage of postgraduate surgical training to allow residents to gain more experience and be better set up for success in the rotation.
ABSTRACT
As healthcare costs continue to rise at unsustainable rates (at an average rate of 5.5% a year), expenses without measurable outcomes need review.1 In reconstructive surgery, empiric change of instruments between oncologic and reconstructive segments of surgery is one such practice. Breast surgery for ductal carcinoma in situ (DCIS), prophylaxis, and partial extirpation has little possible increase in seeding or implantation risk based on the literature. With undue extrapolation from higher risk cancers (such as ovarian), preventative practices of changing out trays, re-gloving, re-gowning, re-preparing, and re-draping between phases persist in operating rooms across the country. From real case costs, the additional expense of 2 surgical setups in the United States is conservatively estimated at $1232 per case, or over $125 million per year for this theoretical risk. Using implantation risk for core breast biopsies as a denominator, this cost is $1.65-$5.8 million per potential recurrence. This is an unacceptably high cost for hypothetical recurrence risk reduction, especially one that does not impact survival outcomes.
