The resident-run operating room in a tertiary referral center in Argentina and a proposal for a new classification of complications in minor surgery

Background: At our Plastic Surgery Department an operating room for minor surgery in charge of residents has been established in order to increase their surgical autonomy as surgeons. On the other hand, minor surgery lacks a standardized classification of postoperative complications based on criteria relevant to plastic surgery. We developed a new classification of surgical complications based on the severity of the intervention required for treatment, the setting in which the patient is treated and the medical costs of treatment. The aim of this study is to evaluate the safety of procedures performed independently by residents and to apply this new classification of complications to minor surgery.
Methods: We retrospectively evaluated 375 patients who were operated at the minor surgery operating room by residents with a follow-up of at least 1 month. The overall complication rate was calculated and the classification system proposed by the authors was applied to assess the severity of complications. Grade A includes complications that are treated in the outpatient setting. Grade B includes those that require the patient to return to the operating room or be hospitalized. Grade C corresponds to life-threatening complications requiring intensive care. Finally, grade D corresponds to the death of the patient. Finally, the Clavien-Dindo classification, which was compared with the latter.
Results: The mean age was 49.9 years and 65.3% were female. The most prevalent diagnoses were cysts (88, 22.2%), lipomas (72, 18.1%), malignant skin lesions (61, 15.4%), dysplastic nevi (56, 14.1%), pathologic scars (24, 6.0%). Among the most frequently performed procedures were simple resection and closure (311, 78.5%), flap reconstruction (39, 9.8%) and earlobe plasty (27, 6.8%). When applying our classification of complications, we recorded a total of 59 complications in 55 (14.6%) patients. Fifty-six (94.9%) complications were mild and managed on an outpatient basis. Thirteen (22.0%) of these complications did not require any additional intervention beyond those expected for the type of surgery (grade A1). On the other hand, thirty-six (61.0%) complications of the same degree of severity required some type of additional behavior or follow-up in the outpatient setting, and were classified as A2. Among the latter, the most frequent complication was small wound dehiscence (7, 1.8%), followed by superficial surgical site infection (6, 1.6%), seroma (5, 1.3%), extruding sutures (5, 1.3%), epidermolysis (3, 0.8%) and hematoma (2, 0.5%), all of which required at least one additional visit to the office for treatment and/or follow-up. Only three (0.8%) patients required reoperation under local anesthesia, with wound dehiscence being the most frequent cause (2, 66.6%). On the other hand, we recorded 20 (33.9%) more complications than using the Dindo-Clavien classification.
Conclusions: The minor surgery operating room under the care of residents is a safe strategy for patients that allows for increased autonomy in procedures. The new classification of complications proposed by the authors makes it possible to record complications that escape the Clavien-Dindo classification and to classify them according to criteria useful to plastic surgeons. This study should be considered as a proof of concept to evaluate its applicability and further studies with a larger cohort of patients should be performed in order to get validation.
Key words: plastic surgery residency; minor surgery; complications; Clavien-Dindo.

Reconstructive

PSTM 2024