Effect of Orthopedic Resident Surgical Education on Surgical Case Length and Healthcare Costs.

PURPOSE: The study investigates the impact of resident involvement in orthopedic hand surgery, focusing on operative and room times, as well as the associated opportunity costs to physicians and the hospital. The primary objective was to examine the impact of resident participation on operative times and total surgical room times in comparison to attending-only procedures. The secondary objective was to assess the cost of resident education by analyzing differences in surgical efficiency for the procedures studied.

METHODS: Data from a single academic teaching hospital were analyzed from 2020 to 2023. All procedures were done by a single fellowship-trained orthopedic hand surgeon, either with or without resident assistance. Procedures assessed included isolated endoscopic carpal tunnel release, isolated trigger finger release, thumb carpometacarpal joint interpositional arthroplasty, and isolated De Quervain release. Statistical differences in operative and total room times were evaluated, and opportunity costs were estimated using the identified differences found in these times.

RESULTS: A total of 1,057 surgical cases were identified. The mean operative and room times were significantly longer when residents were involved in endoscopic carpal tunnel release, trigger finger release, and carpometacarpal procedures. No significant differences were found in mean operative and room times for De Quervain procedures. The estimated total cost, over the entire time period studied, to the hospital for resident involvement was $71,000.07.

CONCLUSIONS: This novel study highlights the cost of resident education in orthopedic hand surgery. Resident surgical involvement is critical to their training. It is evident that there is a substantial cost associated with educating resident physicians that impacts both teaching surgeons and hospitals. The continued development of appropriate compensation models is necessary to continue to encourage resident participation while managing costs effectively.

TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and decision analysis II.