Digestive Disorders Center, Tampa General Hospital, Tampa, FL 33601, USA.
HPB (Oxford). 2010 Feb;12(1):68-72. doi: 10.1111/j.1477-2574.2009.00130.x.
Hospital volume of pancreaticoduodenectomy (PD) and surgeon frequency of PD have been shown to impact outcomes. The impact of surgery residency training programmes after PD is unknown. This study was undertaken to determine the impact of surgery training programmes on outcomes after PD, as well as their importance relative to hospital volume and surgeon frequency of PD.
The State of Florida Agency for Healthcare Administration Database was queried for patients undergoing PD during 2002-2007. Measures of outcome were compared for patients undergoing PD at centres with vs. without surgery residency training programmes.
A total of 2345 PDs were identified, of which 1478 (63%) were undertaken at training centres and 867 (37%) were performed at non-training centres. Patients undergoing PD at training centres had shorter lengths of stay, lower hospital charges and lower in-hospital mortality. Relative to surgeon frequency of PD, training centres had a greater favourable impact on hospital length of stay, hospital charges and in-hospital mortality (P < 0.001 for each, ancova). Relative to hospital volume of PDs undertaken, training centres had a greater impact on hospital charges (P < 0.001, ancova).
Surgery residency training programmes have a favourable effect on outcomes following PD and their impact on outcome is greater than the impact of hospital volume or surgeon frequency of PD.
胰腺十二指肠切除术（PD）的医院容量和外科医生 PD 的手术频率已被证明会影响手术结果。PD 后手术住院医师培训计划的影响尚不清楚。本研究旨在确定手术培训计划对 PD 后结果的影响，以及它们相对于 PD 的医院容量和外科医生手术频率的重要性。
通过佛罗里达州医疗保健管理局数据库查询 2002 年至 2007 年间接受 PD 的患者。比较接受 PD 的患者在有手术住院医师培训计划的中心和没有手术住院医师培训计划的中心的治疗结果。
共确定了 2345 例 PD，其中 1478 例（63%）在培训中心进行，867 例（37%）在非培训中心进行。在培训中心接受 PD 的患者住院时间较短，住院费用较低，院内死亡率较低。与 PD 外科医生手术频率相比，培训中心对住院时间、住院费用和院内死亡率的影响更大（每种情况 P < 0.001，协方差分析）。与 PD 手术量相比，培训中心对住院费用的影响更大（P < 0.001，协方差分析）。
外科住院医师培训计划对 PD 后的结果有有利影响，其对结果的影响大于 PD 的医院容量或外科医生手术频率的影响。
