Article ; Online: The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study.
Journal of clinical anesthesia
2023 Volume 90, Page(s) 111238
Abstract: 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 ...
| Abstract | 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. |
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| MeSH term(s) | Adult ; Humans ; Cohort Studies ; Internship and Residency ; Retrospective Studies ; Anesthesia, General ; Hospitals, University ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology |
| Language | English |
| Publishing date | 2023-08-26 |
| Publishing country | United States |
| Document type | Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 1011618-7 |
| ISSN | 1873-4529 ; 0952-8180 |
| ISSN (online) | 1873-4529 |
| ISSN | 0952-8180 |
| DOI | 10.1016/j.jclinane.2023.111238 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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