The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study
Issued Date
2023-11-01
Resource Type
ISSN
09528180
eISSN
18734529
Scopus ID
2-s2.0-85168814673
Journal Title
Journal of Clinical Anesthesia
Volume
90
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Anesthesia Vol.90 (2023)
Suggested Citation
Beier J., Ahrens E., Rufino M., Patel J., Azimaraghi O., Kumar V., Houle T.T., Schaefer M.S., Eikermann M., Wongtangman K. The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study. Journal of Clinical Anesthesia Vol.90 (2023). doi:10.1016/j.jclinane.2023.111238 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/89285
Title
The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study
Other Contributor(s)
Abstract
Objective: We studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications. Design: Retrospective hospital registry study. Setting: Two university-affiliated hospitals networks (MA and NY, USA). Patients: 140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021. Measurements: Multivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery. Main results: In 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03–1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01–1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02–1.42; p = 0.026, p-for-interaction = 0.056). Conclusion: Patients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.