Improving Autonomy Without Sacrificing Safety—the Value of a Resident Aesthetic Clinic
Sameer Shakir, MD; Geoffrey M. Kozak, MD; Shelby Nathan, MS; Cutler Whitely, BS; Harrison Davis, BS; Robyn B. Broach, PhD; Joshua F. Fosnot, MD
University of Pennsylvania, Division of Plastic Surgery, Philadelphia, PA, USA
Background: For over 25 years, our institution has supported a chief resident aesthetic clinic with the goal to foster autonomy and preparedness for independent practice in a safe environment. The purpose of this study was to compare safety profiles for common aesthetic procedures performed in our resident versus attending clinics.
Methods: Patients (n=525) presenting for aesthetic breast or abdominal surgery at our institution from 2007-2017 were retrospectively reviewed. Two cohorts were identified: subjects undergoing surgery through the chief resident versus attending clinics. Aesthetic procedures queried included 1) augmentation mammoplasty, reduction mammoplasty, or mastopexy, 2) abdominoplasty, 3) combination of 1 and 2, and 4) face lift, blepharoplasty, or rhinoplasty. Demographics, perioperative characteristics, and postoperative complications were compared between cohorts.
Results: Two-hundred-and-sixty-two and 255 subjects underwent breast, abdominal-based, and face/eye aesthetic procedures in the resident and attending clinics, respectively. Subjects presenting to the resident clinic tended to be younger (43.4 vs. 51.4, p<0.001), less obese (26.2 vs. 27.4, p=0.02), lower median income ($65,000 vs. $75,000, p<0.001), and healthier with lower rates of diabetes (4.2% vs. 12.6%, p<0.001), COPD (0.4% vs. 3.1%, p=0.02), PVD (2.3% vs. 6.7%, p=0.02), hypertension (13.4% vs. 31.2%, p<0.001), and history of cancer (3.8% vs. 19.2%, p<0.001). Mean length of procedure significantly differed between resident and attending cohorts at 210 and 152 minutes, respectively (p<0.001). Postoperative complications were similar between cohorts (p=0.48). Reoperation (p<0.03) and readmission (p<0.02) rates were greater in the attending cohorts.
Conclusion: The resident aesthetic clinic provides increases independence and decision-making, while maintaining patient safety in commonly performed breast, abdominal, face/eye procedures. Patients operated on in the resident clinic tended to be younger and healthier, highlighting the importance of careful patient selection to maximize both autonomy and safety.
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