Cost analysis of registrar training in hip and knee arthroplasty before COVID-19

Abstract

Introduction Hospitals often face competing pressures to deliver surgical tuition and provide a service that meets performance targets. However, there are sparse data on the costs of training orthopaedic registrars to carry out procedures compared with consultants. The aim of this study was to evaluate the short-term financial, time and morbidity cost of training registrars in hip and knee joint arthroplasty in our trust. Methods All patients undergoing elective primary hip and knee arthroplasty over a 12-month period in our unit were reviewed retrospectively. Data recorded included grade of primary surgeon, patient demographics, operative time, length of stay, readmission and reoperation within 30 days, and 12-month mortality. Results A total of 889 patients were identified for inclusion in the study. For primary hip arthroplasty performed by registrars, the mean operative time was 126 minutes (standard deviation [SD]: 22 minutes) compared with 98 minutes (SD: 29 minutes) for consultant operations (p < 0.001). The mean length of stay was 5.1 days (SD: 4.3 days) for trainees versus 4.3 days (SD: 2.8 days) for consultants (p = 0.19). For primary knee arthroplasty, the mean trainee operative time was 114 minutes (SD: 20 minutes) compared with 100 minutes (SD: 25 minutes) for consultant operations (p < 0.001). The mean length of stay was 4.0 days (SD: 2.7 days) for trainees versus 4.5 days (SD: 3.5 days) for consultants (p = 0.16). No significant differences were found in complications, readmissions, reoperations or mortality. Conclusions Our study demonstrates no increased morbidity cost to patients following arthroplasty carried out by registrars and the major cost for training was in the increase in operative time associated with registrar performed procedures. With this in mind, careful planning of operating lists can maximise training opportunities while maintaining the efficiency of the unit as a whole.