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Background: Surgical education is evolving as work hour constraints limit the exposure of residents to the operating room. Potential consequences may include erosion of resident education and decreased quality of patient care. Surgical simulation training has become a focus of study in an effort to counter these challenges. Previous studies have validated the use of arthroscopic surgical simulation programs both in vitro and in vivo. However, no study has examined if the gains made by residents after a simulation program are retained after a period away from training., Methods: In all, 17 orthopedic surgery residents were randomized into simulation or standard practice groups. All subjects were oriented to the arthroscopic simulator, a 14-point anatomic checklist, and Arthroscopic Surgery Skill Evaluation Tool (ASSET). The experimental group received 1 hour of simulation training whereas the control group had no additional training. All subjects performed a recorded, diagnostic arthroscopy intraoperatively. These videos were scored by 2 blinded, fellowship-trained orthopedic surgeons and outcome measures were compared within and between the groups. After 1 year in which neither group had exposure to surgical simulation training, all residents were retested intraoperatively and scored in the exact same fashion. Individual surgical case logs were reviewed and surgical case volume was documented., Results: There was no difference between the 2 groups after initial simulation testing and there was no correlation between case volume and initial scores. After training, the simulation group improved as compared with baseline in mean ASSET (p = 0.023) and mean time to completion (p = 0.01). After 1 year, there was no difference between the groups in any outcome measurements., Conclusion: Although individual technical skills can be cultivated with surgical simulation training, these advancements can be lost without continued education. It is imperative that residency programs implement a simulation curriculum and continue to train throughout the academic year., (Published by Elsevier Inc.)

Background: Total shoulder arthroplasty (TSA) is an increasingly used treatment of glenohumeral arthritis and proximal humerus fractures. However, patient-specific characteristics affecting length of hospital stay postoperatively have not been elucidated., Methods: All patients undergoing primary unilateral TSA between 2005 and 2011 were isolated from the National Surgical Quality Improvement Program database. Patient demographics, medical comorbidities, and selected surgical variables were extracted, and length of stay was established as the primary end point of interest. Risk factors were expressed as odds ratios (ORs) with 95% confidence intervals by bivariate and multivariable analysis., Results: A total of 2004 patients were identified; the average age was 68.8 years, and 57% were women. Mean length of stay after TSA was 2.2 days (standard deviation, 1.7), and 91% of cases received hospital discharge in <3 days. Multivariable logistic regression analysis identified renal insufficiency (OR, 11.35; P = .0002), increased age (OR, 2.13; P = .011), longer operative time (OR, 1.94; P = .0041), and American Society of Anesthesiologists class ≥3 (OR, 1.86; P = .0016) as the most significant risk factors for length of stay. Gender also influenced length of stay; women were more likely to stay ≥4 days (OR, 0.44; P < .0001)., Conclusions: Perioperative risk stratification and preoperative counseling are paramount for patients undergoing TSA, particularly for those individuals with cardiac and renal disease or of advancing age. These variables may effectively predict prolonged hospital stay after TSA., (Published by Elsevier Inc.)