The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database (2005 to 2010) was queried using Current Procedural Terminology codes (American Medical Association, Chicago, Ill) for below-knee amputation (27880, 27882) and above knee-amputation (27590, 27592). Resident involvement was defined using the NSQIP variable and was narrowed to postgraduate year 1 to 5. Variables associated with resident involvement were identified, and mortality, morbidity, intraoperative transfusion, and operative time (75th percentile vs the bottom three quartiles) were evaluated as distinct categoric end points in logistic regression. Included in the model were variables with a P value?<.1 on ¦Ö2 or independent t-test, as appropriate. Significance was defined at P?< .05.
Residents were involved in 6587 of 11,038 amputations (62 % ). After adjustment for preoperative and intraoperative factors on logistic regression, there was a significant increase in major morbidity (odds ratio [OR], 1.27; 95 % confidence interval [CI], 1.14-1.42; P?< .001), intraoperative transfusion (OR, 1.78; 95 % CI, 1.50-2.11; P?< .001), and operative time (OR, 1.64 95 % CI, 1.46-1.84; P?< .001) in resident cases.
Resident involvement was associated with increased odds of major morbidity after amputation and also with increased operative time and risk for intraoperative transfusions.