Baskett Roger J F, Kalavrouziotis Dimitri, Buth Karen J, Hirsch Gregory M, Sullivan John A P
The Maritime Heart Center, Halifax, Nova Scotia, Canada.
Ann Thorac Surg. 2004 Oct;78(4):1236-40. doi: 10.1016/j.athoracsur.2004.04.041.
The safety of training residents in complex procedures has not been elucidated. In particular, the impact of resident-performed mitral valve surgery on patient outcomes is unknown.
All mitral valve procedures performed by residents between 1998 and 2003 were compared with those performed by staff surgeons. Operative mortality and a composite morbidity (reoperation for bleeding, myocardial infarction, infection, stroke, or ventilation > 24 hours) were compared using multivariate analysis. Individual outcomes were compared with the use of propensity scores.
There were 1020 cardiac surgeries performed by residents, including 165 mitral valve procedures (86 replacements, 79 repairs). In the same period, the staff surgeons performed 261 mitral procedures. Crude operative mortality for isolated mitral procedures was 5.4% and 4.7% (resident and staff, respectively, p = 1.00). Mitral valve repair including combined procedures had an operative mortality of 3.8% and 4.3% (resident and staff, respectively, p = 1.00). The composite morbidity outcome was 29.7% and 35.3% for resident and staff-performed cases, respectively (p = 0.24). In multivariate analysis, resident was not associated with the adverse outcomes examined (OR 0.80, 95% CI, 0.47, 1.37). The incidence of major adverse outcomes for propensity score-matched mitral valve cases, including combined procedures, were similar between residents and staff, respectively: mortality, 7.4% versus 8.7% (p = 0.67), stroke, 4.0% versus 6.7% (p = 0.30), and reoperation for bleeding, 4.7% versus 9.4% (p = 0.11).
There were no significant differences in morbidity and mortality in patients undergoing mitral valve surgery between resident and staff surgeons. It is possible to train residents to perform complex cardiac cases without adversely affecting outcomes.
培训住院医师进行复杂手术的安全性尚未阐明。特别是，住院医师进行二尖瓣手术对患者预后的影响尚不清楚。
将1998年至2003年间住院医师进行的所有二尖瓣手术与外科医生进行的手术进行比较。使用多变量分析比较手术死亡率和综合发病率（因出血、心肌梗死、感染、中风或通气超过24小时而再次手术）。使用倾向评分比较个体预后。
住院医师进行了1020例心脏手术，包括165例二尖瓣手术（86例置换术，79例修复术）。同期，外科医生进行了261例二尖瓣手术。单纯二尖瓣手术的粗手术死亡率分别为5.4%和4.7%（住院医师和外科医生，p = 1.00）。包括联合手术在内的二尖瓣修复术的手术死亡率分别为3.8%和4.3%（住院医师和外科医生，p = 1.00）。住院医师和外科医生实施的病例的综合发病率结果分别为29.7%和35.3%（p = 0.24）。在多变量分析中，住院医师与所检查的不良预后无关（OR 0.80，95% CI，0.47，1.37）。倾向评分匹配的二尖瓣病例（包括联合手术）的主要不良预后发生率在住院医师和外科医生之间相似，分别为：死亡率，7.4%对8.7%（p = 0.67），中风，4.0%对6.7%（p = 0.30），以及因出血再次手术，4.7%对9.4%（p = 0.11）。
住院医师和外科医生进行二尖瓣手术的患者的发病率和死亡率没有显著差异。培训住院医师进行复杂心脏病例手术而不影响预后是可能的。
