Evaluation of the impact of residents’ participation on free flap reconstruction

Background: As microsurgery gains in popularity, surgical training becomes more critical. There have been numerous studies assessing resident involvement in an array of surgical subspecialties; however, there is a dearth of data as it relates to patient outcomes in the field of Reconstructive Microsurgery. Methods: A retrospective review was conducted by searching for all free tissue transfer cases from 2011 to 2012 in the NSQIP database. Study groups were divided based on presence of a resident. The flaps were then subdivided into type of free flap. The primary outcome was the development of major complications, defined as return to OR or flap loss. Secondary outcomes were total hospital length of stay, total operative time, and minor complications defined as surgical site infection, wound dehiscence, and bleeding not requiring return to OR or readmission. Results: A total of 462 free tissue transfers were identified, 92 of which were performed without resident participation, and 369 included resident participation. The majority of flaps of cases were done for breast reconstruction. After adjusting for comorbidities, cases in which residents participated had a statistically significant increase in bleeding, SSI, and total operative time. Interestingly, cases involving a PGY-6 and above conferred a protective effect from developing major complications. Conclusions: Resident involvement in Reconstructive Microsurgery cases is safe, with only a slightly higher probability of minor complications. There was no difference in major complications, and in fact, having a chief resident and above participate in the case conferred a protective effect. Attending surgeons can be confident that their patients will be safe, and that involving residents will not negatively affect their outcomes. Level of evidence: Level III, risk/prognostic study.