Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card: An initial experience. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Halani, Sameer H.; Cho, Min-Jeong; Garibay, Maycie; Nevin, Julia; Zhang, Andrew Y.
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 73:Issue 7(2020)
• Page Start: 1338
• Page End: 1347
• Publication Date: 2020-07
• Subjects: Resident education -- Breast reconstruction -- Surgical report card -- Tissue-expanders; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2020.02.019
• Languages: English
• ISSNs: 1748-6815

Abstract

Summary: 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.