TY - JOUR
T1 - The impact of residency training level on early postoperative desaturation
T2 - A retrospective multicenter cohort study
AU - Beier, Juliane
AU - Ahrens, Elena
AU - Rufino, Michael
AU - Patel, Jashvin
AU - Azimaraghi, Omid
AU - Kumar, Vivek
AU - Houle, Timothy T.
AU - Schaefer, Maximilian S.
AU - Eikermann, Matthias
AU - Wongtangman, Karuna
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/11
Y1 - 2023/11
N2 - Objective: We studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications. Design: Retrospective hospital registry study. Setting: Two university-affiliated hospitals networks (MA and NY, USA). Patients: 140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021. Measurements: Multivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery. Main results: In 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03–1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01–1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02–1.42; p = 0.026, p-for-interaction = 0.056). Conclusion: Patients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.
AB - Objective: We studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications. Design: Retrospective hospital registry study. Setting: Two university-affiliated hospitals networks (MA and NY, USA). Patients: 140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021. Measurements: Multivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery. Main results: In 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03–1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01–1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02–1.42; p = 0.026, p-for-interaction = 0.056). Conclusion: Patients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.
KW - Evaluate patient outcome
KW - Medical education research
KW - Perioperative respiratory complication
KW - Residency training
KW - Safe patient care
UR - http://www.scopus.com/inward/record.url?scp=85168814673&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85168814673&partnerID=8YFLogxK
U2 - 10.1016/j.jclinane.2023.111238
DO - 10.1016/j.jclinane.2023.111238
M3 - Article
C2 - 37639750
AN - SCOPUS:85168814673
SN - 0952-8180
VL - 90
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
M1 - 111238
ER -