Palm Henrik, Jacobsen Steffen, Krasheninnikoff Michael, Foss Nicolai Bang, Kehlet Henrik, Gebuhr Peter
Department of Orthopaedic Surgery, Copenhagen University Hospital of Hvidovre, Denmark.
Injury. 2007 Jul;38(7):775-9. doi: 10.1016/j.injury.2006.07.043. Epub 2006 Oct 17.
To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF).
Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding.
Unsupervised junior registrars operated on 23% (137/600) of all and 15% (56/365) of technically demanding proximal femoral fractures. The latter had a higher re-operation rate within 6 months, compared with the rate when more experienced surgeons were present. In logistic regression analysis combining age, gender, American Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures.
Unsupervised junior registrars should not operate on technically demanding proximal femoral fractures.
探讨手术医生的经验及监督程度对股骨近端骨折（PFF）患者再次手术率的影响。
对2002年至2004年间在我们多模式康复项目中连续收治的600例股骨近端骨折患者进行前瞻性研究。术后6个月评估再次手术率。外科医生分为无监督的初级住院医生与有经验的手术或监督医生。骨折分为技术上要求不高或要求高的类型。
无监督的初级住院医生进行了所有手术的23%（137/600），以及技术上要求高的股骨近端骨折手术的15%（56/365）。与有经验的外科医生在场时相比，后者在6个月内的再次手术率更高。在结合年龄、性别、美国麻醉医师协会评分、新活动能力评分、手术时间和植入物类型的逻辑回归分析中，无监督的初级住院医生进行的手术仍是技术上要求高的股骨近端骨折再次手术的显著独立危险因素。
无监督的初级住院医生不应进行技术上要求高的股骨近端骨折手术。
