Effect of Trainee Level on Surgical Time and Postoperative Complications of Anterior Cruciate Ligament Reconstruction.

PURPOSE: The objective of this study was to investigate the association between trainee level and surgical time and postoperative complications of anterior cruciate ligament reconstruction (ACLR). METHODS: A retrospective chart review of patients who underwent ACLR at an academic orthopaedic ambulatory surgery center collected demographic and clinical information, including the number of trainees present and trainee level. Unadjusted and adjusted regression analyses assessed the association between trainee number and level with surgical time (time from skin incision to closure) and postoperative complications. RESULTS: Of 799 patients in this study operated on by one of five academic sports surgeons, 87% had at least one trainee involved. The average surgical time overall was 93 ± 21 minutes and by trainee level was 99.7 (junior resident), 88.5 (senior residents), 96.6 (fellows), and 95.6 (no trainees). Trainee level was significantly associated with surgical time (P = 0.0008), with increased surgical time in cases involving fellows (0.0011). Fifteen complications (1.9%) were observed within 90 days of surgery. No notable risk factors of postoperative complications were identified. CONCLUSION: Resident trainee level does not have a notable effect on surgical time or postoperative complications for ACLR at an ambulatory surgery center, although cases involving fellows had longer surgical times. Trainee level was not associated with risk of postoperative complications.

Eliciting Stuttering in School-Age and Adolescent Stutterers in Experimental Settings.

PURPOSE: Most neural and physiological research on stuttering focuses on the fluent speech of speakers who stutter due to the difficulty associated with eliciting stuttering reliably in the laboratory. We previously introduced an approach to elicit stuttered speech in the laboratory in adults who stutter. The purpose of this study was to determine whether that approach reliably elicits stuttering in school-age children and teenagers who stutter (CWS/TWS). METHOD: Twenty-three CWS/TWS participated. A clinical interview was used to identify participant-specific anticipated and unanticipated words in CWS and TWS. Two tasks were administered: (a) a delayed word reading task in which participants read words and produced them after a 5-s delay and (b) a delayed response question task in which participants responded to examiner questions after a 5-s delay. Two CWS and eight TWS completed the reading task; six CWS and seven TWS completed the question task. Trials were coded as unambiguously fluent, ambiguous, and unambiguously stuttered. RESULTS: The method yielded, at a group level, a near-equal distribution of unambiguously stuttered and fluent utterances: 42.5% and 45.1%, respectively, in the reading task and 40.5% and 51.4%, respectively, in the question task. CONCLUSIONS: The method presented in this article elicited a comparable amount of unambiguously stuttered and fluent trials in CWS and TWS, at a group level, during two different word production tasks. The inclusion of different tasks supports the generalizability of our approach, which can be used to elicit stuttering in studies that aim to unravel the neural and physiological bases that underlie stuttered speech.

Cost-Effectiveness of Pediatric Hand International Medical Missions.

PURPOSE: Limited access and resources in low- and middle-income countries leave many individuals deprived of medical care. Surgical mission trips offer a solution to provide sound surgical care to underserved areas but require a sizable financial support. Previous analyses of such trips have not included values of donated supplies and costs borne by the host country. We hypothesized that the orthopedic mission trips, utilizing the World Pediatric Project (WPP) model, can be executed in a cost-effective manner according to the World Health Organization thresholds even when considering cost to the organizations and host country. METHODS: World Pediatric Project records for the most recent pediatric upper extremity orthopedic mission trips of 2016, 2018, and 2019 were obtained. Cost estimates were based on documentation from each of the mission trips. Total costs included the costs borne by the WPP, estimates of the value of donated supplies, and costs borne by the host country. The cost-effectiveness of the surgical mission trips was determined by the total cost and potential benefit of performing the orthopedic surgeries using disability-adjusted life years averted. RESULTS: Three separate mission trips to St. Vincent and the Grenadines were analyzed. Forty-five pediatric patients had received surgical care. The cost was calculated to be $431.50 per disability-adjusted life years averted when only the WPP costs are considered; including donated supplies and cost borne by the host country in the total cost, the cost was $6898.10 per disability-adjusted life years averted. After comparing the cost values to the per capita gross domestic product of St. Vincent and the Grenadines, $7,463.54, the WPP mission trips were determined to be cost-effective according to the WHO-CHOICE thresholds in all 5 categories. CONCLUSIONS: Orthopedic medical mission trips can provide cost-effective surgical treatments for the upper extremity even when the costs to the organization and host country and trip donations are considered. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analysis III.