First Assistant Training Level Does Not Impact Postoperative Outcomes and Complications Following Varus Derotational Osteotomy in Patients With Cerebral Palsy.

Introduction: The influence of the first assistant's training level on outcomes of orthopaedic surgery in children with cerebral palsy (CP) remains unknown. As such, this study aims to evaluate the effects of first assistant training level (resident vs. fellow) on perioperative and postoperative outcomes following proximal femoral varus derotational osteotomy (VDRO) in children with CP.

Methods: Pediatric patients (age <18 y) with CP who underwent VDRO by a single fellowship-trained pediatric orthopaedic surgeon between 2017 and 2021 were retrospectively reviewed. Patients with a minimum of 2-year follow-up were included. Demographic data, training level of first assistant, and perioperative surgical characteristics (operative time, operating room time, estimated blood loss, length of stay, and peri- and postoperative complications) were recorded. Acute complications (≤ 90 d postoperatively) included medical complications, surgical site infection (SSI), peri-prosthetic fractures, emergency department visits, hospital readmission, and revision surgery. Long-term complications (>90 d postoperatively) included delayed/nonunion, re-subluxation, SSI, symptomatic hardware, and revision surgery. Preoperative and minimum 1-year postoperative migration percentages (MPs) were collected. t tests, χ2 test, and Fisher exact test were used to detect differences between complication rates and outcomes between resident-assisted (group A) and fellow-assisted (group B) cases.

Results: Sixty-nine patients were included for analysis (group A: 27; group B: 42). Demographic data, medical comorbidities, and surgical complexity were comparable between groups. Perioperative surgical characteristics, acute complications, and long-term complications were equivalent between groups (P>0.05). Minimum 1-year postoperative MPs were lower in group A than group B (1% vs. 7.5%, P<0.001). No patients had MP≥40% at 1-year postoperatively in either group.

Conclusion: Despite the high surgical and medical complexity of osseous hip reconstructions for children with CP, postoperative outcomes are not impacted by the first assistant's training level. While postoperative MPs were slightly lower for patients in the resident-assisted group, these differences were not clinically significant, and 1-year radiographic outcomes were comparable. Resident surgeons should be encouraged to participate in VDRO cases, and families should be reassured that resident participation will not negatively affect outcomes.