The impact of surgery resident training on the duration of tibial plateau leveling osteotomy surgery

Atsushi Niida, Po-Yen Chou, Barbro Filliquist, Denis J Marcellin-Little, Amy S Kapatkin, Philip H Kass
Vet Surg. 2024 May 19. doi: 10.1111/vsu.14113.

Objective: To investigate the impact of surgery resident training on surgery duration in tibial plateau leveling osteotomy (TPLO) and evaluate whether surgery duration differs with each year of residency training.

Study design: Retrospective medical record review.

Animals: A total of 256 client-owned dogs underwent TPLO.

Methods: Records of dogs that underwent TPLO between August 2019 and August 2022 were reviewed. The effects of the surgeon (faculty/resident) and the procedure (arthrotomy/arthroscopy) on TPLO surgery duration were examined with an analysis of variance, and geometric least squares means (GLSM) were compared. A linear mixed effects model (LMM) was fitted to quantify fixed and random effects.

Results: Four faculty surgeons performed 74 (29%) TPLOs, while 10 residents performed 182 (71%) TPLOs under the direct supervision of a faculty surgeon. All TPLOs were conducted with arthrotomy (109; 43%) or arthroscopy (147; 57%). Overall, residents (GLSM, 153 min) required 54% more surgery duration than faculty surgeons (GLSM, 99 min). Surgery duration among first-year residents (GLSM, 170 min) was 15% longer than second- (GLSM, 148 min) and third-year (GLSM, 147 min) residents, whereas the duration did not differ statistically between second- and third-year residents. Arthroscopy, meniscal tear treatment, surgery on the right stifle, and increasing patient weight were also associated with longer surgery duration.

Conclusion: The duration of TPLO surgery significantly decreased after the first year of residency, but did not decrease afterward.

Clinical significance: The results will aid with resource allocation, curricula planning, and cost management associated with resident training.