Lee Steven L, Yaghoubian Arezou
Division of Pediatric Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
J Laparoendosc Adv Surg Tech A. 2010 Dec;20(10):863-5. doi: 10.1089/lap.2010.0114. Epub 2010 Sep 27.
With heightened emphasis on patient safety, it is important to document the effect of residents acting as the surgeon. This study compares the outcomes of laparoscopic appendectomy (LA) in children between teaching and nonteaching institutions.
A retrospective review of all patients <18 years undergoing LA for appendicitis over a 10-year period was performed. The outcomes from 2 teaching institutions were compared with 10 nonteaching institutions. Study outcomes included postoperative morbidity (wound infection, abscess drainage, and readmission) and length of hospitalization (LOH).
Five hundred forty-two patients were treated at the teaching institution (mean age = 11 years, 62% male) and 3012 at the nonteaching institution (mean age = 13 years, 60% male). The perforated appendicitis rate was 33% at the teaching institution and 22% at the nonteaching institution (P < 0.0001). In patients with nonperforated appendicitis, rates of wound infection, abscess drainage, and readmission were similar between the institutions. However, for perforated appendicitis, rates of wound infection, abscess drainage, and readmission were all lower at the teaching institutions. LOH was longer at the teaching institutions for both nonperforated and perforated appendicitis.
The morbidity for LA was significantly lower in children with perforated appendicitis at the teaching institutions, whereas morbidity for nonperforated appendicitis was similar. LOH was longer in the teaching institutions. Overall, the presence of surgical trainees had minimal adverse impact on the outcomes of LA in children with appendicitis.
随着对患者安全的重视程度不断提高，记录住院医师作为外科医生的手术效果非常重要。本研究比较了教学医院和非教学医院儿童腹腔镜阑尾切除术（LA）的手术结果。
对10年间所有18岁以下因阑尾炎接受LA手术的患者进行回顾性研究。将2家教学医院的结果与10家非教学医院的结果进行比较。研究结果包括术后发病率（伤口感染、脓肿引流和再次入院）和住院时间（LOH）。
教学医院治疗了542例患者（平均年龄11岁，62%为男性），非教学医院治疗了3012例患者（平均年龄13岁，60%为男性）。教学医院的穿孔性阑尾炎发生率为33%，非教学医院为22%（P<0.0001）。在非穿孔性阑尾炎患者中，各机构的伤口感染、脓肿引流和再次入院率相似。然而，对于穿孔性阑尾炎，教学医院的伤口感染、脓肿引流和再次入院率均较低。教学医院非穿孔性和穿孔性阑尾炎的住院时间均较长。
教学医院中穿孔性阑尾炎儿童LA的发病率显著较低，而非穿孔性阑尾炎的发病率相似。教学医院的住院时间较长。总体而言，外科实习生的存在对阑尾炎儿童LA的手术结果影响最小。
