Is there an impact of surgeon's experience on in-hospital outcome in patients with operatively treated proximal humerus and humerus shaft fractures?

Abstract

Background

Proximal humerus and shaft fractures are common, comprising 10–11 % of all fractures. Progress in their management includes refined surgical techniques and implants, coupled with a deeper understanding of fracture patterns.

Aims

This study examines the effect of surgical education on in-hospital outcomes for operatively treated proximal and humerus shaft fractures, aiming to enhance patient care and results.

Material and Methods

This study analyzed cases from 1st of January 2010 until the 31st of December 2021 using data extracted from the Swiss working group for quality assurance in surgery, including patients with proximal humerus and shaft fractures who underwent surgical procedures like open reduction with internal fixation (ORIF), closed reduction with internal fixation (CRIF), external fixation, or prosthesis. Analysis included patient demographics, procedure details, and outcomes, comparing those with and without teaching of the surgical procedures. Binary logistic regression identified risk factors, with statistical significance set at p = 0.001.

Results

A total of 6,654 patients were analyzed. Most were treated with ORIF (74 %) or CRIF (17 %). The average hospital stay was 6.5 days. Teaching surgeries, comprising 5.4 % of all procedures, were more common among patients with fewer comorbidities and with public insurance coverage. These surgeries took slightly longer to perform compared to non-teaching cases (120±65 min vs. 113±60 min, p= <0.001). Public insurance coverage, absence of comorbidities, and certain surgical procedures (CRIF and ORIF vs. prosthesis) were associated with surgery being a teaching case. Complications occurred in 8 % of patients, with no significant difference between teaching and non-teaching groups. Predictors of complications included higher American Society of Anesthesiologists-score, antibiotic use, anticoagulation therapy, fracture of shaft, higher age, and longer surgery duration.

Conclusions

Educational status did not affect in-hospital mortality and morbidity in patients with a operatively treated shaft or proximal humeral fracture. However, teaching was an independent predictor of a prolonged duration of surgery. Despite the significant differences, the clinical outcome was comparable in both groups, therefore substantiating the advantages of teaching operations for both patient safety and resident education. They combine the competence of experienced surgeons with the training of residents, whilst ensuring the safety through oversight and best practices. Not only does this environment improve patient outcomes, but also provides residents with hands-on experience, thus helping them make critical decisions, building confidence and developing essential skills.