Does resident involvement in tonsillectomy affect outcomes?

Deepthi S Akella; Ellen M Piccillo; Gaayathri Varavenkataraman; Jason C DeGiovanni; Francesca C Viola; Michele M Carr

doi:10.1016/j.amjoto.2024.104313

Does resident involvement in tonsillectomy affect outcomes?

Am J Otolaryngol. 2024 Apr 16;45(4):104313. doi: 10.1016/j.amjoto.2024.104313. Online ahead of print.

Authors

Deepthi S Akella¹, Ellen M Piccillo², Gaayathri Varavenkataraman², Jason C DeGiovanni², Francesca C Viola², Michele M Carr³

Affiliations

¹ University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA.
² Department of Otolaryngology, Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
³ Department of Otolaryngology, Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. Electronic address: mcarr@buffalo.edu.

PMID: 38657537
DOI: 10.1016/j.amjoto.2024.104313

Abstract

Objective: Tonsillectomy is essentially a solo surgery with a well-described complication profile. It may serve as a good benchmark to evaluate the resident-as-surgeon. This study examined complications such as post-tonsillectomy bleeding in children undergoing tonsillectomy by attending surgeons (AS) or pediatric otolaryngologist-supervised residents.

Methods: Charts were reviewed of all children aged 12 and under who had tonsillectomy +/- adenoidectomy at a children's hospital between Jan 2019 and Dec 2020. Patient age, gender, BMI, indication for surgery, surgical technique, presence of a resident surgeon, primary bleeding, secondary bleeding, treatment of bleeding, other Emergency Room (ER) visits, and clinic phone calls were recorded. Binary logistic regression was performed.

Results: 2051 total children (1092 (53.2 %) males and 956 (46.6 %) females) with a mean age of 6.1 years (95 % CI 6.0-6.2) were included. 1910 (93.0 %) underwent surgery for tonsillar obstruction. 1557 (75.9 %) underwent monopolar cautery tonsillectomy. 661 (32.2 %) had a resident surgeon. 274 (13.4 %) had a related ER visit within 15 days. 18 (0.9 %) had a primary bleed and 155 (7.6 %) had a secondary bleed. Binary logistic regression showed that significant predictors of postoperative ER visits were patient age (OR = 1.101, 95 % CI = 1.050-1.154, p < .001) and resident involvement (OR = 0.585, 95 % CI = 0.429-,797, p < .001). Only age was associated with overall postoperative bleeding incidence (OR = 1.131, 95 % CI = 1.068-1.197, p < .001), as well as secondary bleeding (OR = 1.128, 95 % CI = 1.063-1.197, p < .001). There were no significant predictors of primary bleeding.

Conclusion: Resident involvement in pediatric tonsillectomy is associated with decreased postoperative ER utilization and does not appear to increase common postoperative complications including bleeding and dehydration.

Keywords: Complications; Post tonsillectomy bleeding; Resident education; Surgical outcomes; Tonsillectomy.