TY - JOUR
T1 - Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card
T2 - An initial experience
AU - Halani, Sameer H.
AU - Cho, Min Jeong
AU - Garibay, Maycie
AU - Nevin, Julia
AU - Zhang, Andrew Y.
N1 - Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/7
Y1 - 2020/7
N2 - Background: The practice of tracking and analyzing surgical outcomes is essential to becoming better surgeons. However, this feedback system is largely absent in residency training programs. Thus, we developed a Surgery Report Card (SRC) for residents performing tissue expander (TE)–based breast reconstruction and report our initial experience with its implementation. Methods: We performed a systematic review and meta-analysis for TE-based breast reconstructions and compared outcomes to our retrospective cohort. The primary outcome was overall complications. The SRC compares patient and complication statistics for resident-led teams to the meta-analysis. Results: The meta-analysis included 12 studies, with 2093 patients (2982 breasts) that underwent TE-based reconstruction. The pooled complication rate was 26.9%; infection was most common (8.3%); failure rate was 5.9%. Our cohort included 144 patients (245 breasts) among 13 resident-led teams. Overall complication rate was 31.8%; infections were most frequent (17.6%) and failure rate was 7.3%. Our cohort had significantly higher BMIs (29.7 vs 25.4, p<0.0001) more diabetics (6.9% vs. 3.2%, p = 0.02), and more patients receiving adjuvant radiation therapy (41.4 vs 26.3%, p<0.0001). Every 3 months, residents receive a customized SRC of their cases, with the meta-analysis used as a benchmark. A survey demonstrated the SRC made residents reconsider surgical technique and more conscientious surgeons, and would like it implemented for other procedures during residency. Conclusions: The implementation of our SRC for TE-based breast reconstruction establishes a baseline for surgical performance comparison for residents, demonstrates that residents can safely perform the procedure, and allows for critiquing of surgical techniques to improve patient care.
AB - Background: The practice of tracking and analyzing surgical outcomes is essential to becoming better surgeons. However, this feedback system is largely absent in residency training programs. Thus, we developed a Surgery Report Card (SRC) for residents performing tissue expander (TE)–based breast reconstruction and report our initial experience with its implementation. Methods: We performed a systematic review and meta-analysis for TE-based breast reconstructions and compared outcomes to our retrospective cohort. The primary outcome was overall complications. The SRC compares patient and complication statistics for resident-led teams to the meta-analysis. Results: The meta-analysis included 12 studies, with 2093 patients (2982 breasts) that underwent TE-based reconstruction. The pooled complication rate was 26.9%; infection was most common (8.3%); failure rate was 5.9%. Our cohort included 144 patients (245 breasts) among 13 resident-led teams. Overall complication rate was 31.8%; infections were most frequent (17.6%) and failure rate was 7.3%. Our cohort had significantly higher BMIs (29.7 vs 25.4, p<0.0001) more diabetics (6.9% vs. 3.2%, p = 0.02), and more patients receiving adjuvant radiation therapy (41.4 vs 26.3%, p<0.0001). Every 3 months, residents receive a customized SRC of their cases, with the meta-analysis used as a benchmark. A survey demonstrated the SRC made residents reconsider surgical technique and more conscientious surgeons, and would like it implemented for other procedures during residency. Conclusions: The implementation of our SRC for TE-based breast reconstruction establishes a baseline for surgical performance comparison for residents, demonstrates that residents can safely perform the procedure, and allows for critiquing of surgical techniques to improve patient care.
KW - Breast reconstruction
KW - Resident education
KW - Surgical report card
KW - Tissue-expanders
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U2 - 10.1016/j.bjps.2020.02.019
DO - 10.1016/j.bjps.2020.02.019
M3 - Article
C2 - 32241736
AN - SCOPUS:85082534926
SN - 1748-6815
VL - 73
SP - 1338
EP - 1347
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
IS - 7
ER -