How does the presence of a surgical trainee impact patient outcomes in lumbar fusion surgery?

Srikanth N. Divi, Dhruv K.C. Goyal*, Eve Hoffman, William K. Conaway, Matt Galtta, Daniel R. Bowles, Nathan V. Houlihan, Joseph F. Bechay, Richard M. McEntee, I. David Kaye, Mark F. Kurd, Barrett I. Woods, Kris E. Radcliff, Jeffery A. Rihn, D. Greg Anderson, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: While the impact of trainee involvement in other surgical fields is well established, there is a paucity of literature assessing this relationship in orthopaedic spine surgery. The goal of this study was to further elucidate this relationship. Methods: A retrospective cohort study was initiated on patients undergoing 1-3 level lumbar spine fusion at a single academic center. Operative reports from cases were examined, and patients were divided into 2 groups depending on whether a fellow or resident (F/R) or a physician's assistant (PA) was used as the primary assist. Patients with less than 1-year follow-up were excluded. Multiple linear regression was used to assess change in each patient-reported outcome, and multiple binary logistic regression was used to determine significant predictors of revision, infection, and 30- or 90-day readmission. Results: One hundred and seventy-two patients were included in the F/R group compared with 178 patients in the PA group. No differences existed between groups for total surgery time, length of stay, 30- or 90-day readmissions, infection, or revision rates. No differences existed between groups in terms of patient-reported outcomes preoperatively or postoperatively. In addition, presence of a surgical trainee was not a significant predictor of patient outcomes or rates of infection, overall revision, or 30- and 90-day readmission rates. Conclusions: The results of this study indicate the presence of an orthopaedic spine F/R does not increase complication rates and does not affect short-term patient-reported outcomes in lumbar decompression and fusion surgery.

Original languageEnglish (US)
Pages (from-to)471-477
Number of pages7
JournalInternational Journal of Spine Surgery
Issue number3
StatePublished - Jun 1 2021
Externally publishedYes


  • Arthrodesis
  • Fellow
  • Infection
  • PA
  • PROMs
  • Patient-reported outcome measurements
  • Physician's assistant
  • Readmission
  • Resident
  • Revision

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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