Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Surgery. 2010 Dec;148(6):1065-71; discussion 1071-2. doi: 10.1016/j.surg.2010.09.010.
Historically, a high percentage of endocrine surgical procedures are performed by general surgeons in nonteaching environments. With the institution of accredited fellowships, we sought to determine whether that dynamic is changing.
The American College of Surgeons-National Surgeons Quality Improvement Program was queried for all thyroid, parathyroid, and adrenal operations performed during 2005-2008. Resident assistance was classified as none, junior (postgraduate years 1-3), senior (postgraduate years 4 and 5) or fellow (≥ postgraduate year 6). Data were also examined for associations between resident/fellow assistance and surgical outcomes.
In all, 24.7% of endocrine operations (7,140/29,161) were performed by an attending surgeon operating alone (17.1% adrenals, 27.4% thyroids, and 20.6% parathyroids). Fellows assisted in 6.6% of operations (18.3% adrenals, 4.7% thyroids, and 8.2% parathyroids; 2006: 586 operations, 2007: 629 operations, and 2008: 720 operations). Comparing attending surgeons operating alone with those assisted by residents/fellows, they had shorter operative times (P < .001), longer surgical duration of stay (parathyroid: 1.73 days, thyroid: 1.80 days, P < .001), and a higher prevalence of obese, diabetic, or octogenarian patients. However, no significant difference was found in the rates of wound infections, medical complications, return to the operating room, or overall morbidity.
Even with the increase in endocrine surgery fellowships, almost one fourth of all endocrine operations are still performed by attending surgeons operating alone. Although operations assisted by residents/fellows took longer and patients had a greater duration of stay, there were no significant differences in measured outcomes.
历史上，很大比例的内分泌外科手术是由非教学环境中的普通外科医生完成的。随着认证奖学金的设立，我们试图确定这种动态是否正在发生变化。
美国外科医师学院-国家外科医生质量改进计划（American College of Surgeons-National Surgeons Quality Improvement Program）被查询了 2005-2008 年间所有甲状腺、甲状旁腺和肾上腺手术。住院医师的协助被分为无、初级（研究生第 1-3 年）、高级（研究生第 4-5 年）或研究员（≥研究生第 6 年）。还检查了住院医师/研究员协助与手术结果之间的关系。
在所有内分泌手术中，有 24.7%（7140/29161）是由单独操作的主治外科医生完成的（肾上腺占 17.1%，甲状腺占 27.4%，甲状旁腺占 20.6%）。研究员协助进行了 6.6%的手术（肾上腺占 18.3%，甲状腺占 4.7%，甲状旁腺占 8.2%；2006 年：586 例手术，2007 年：629 例手术，2008 年：720 例手术）。与单独操作的主治外科医生相比，接受住院医师/研究员协助的外科医生手术时间更短（P<0.001），手术住院时间更长（甲状旁腺：1.73 天，甲状腺：1.80 天，P<0.001），肥胖、糖尿病或 80 岁以上患者的比例更高。然而，在伤口感染、医疗并发症、返回手术室或整体发病率方面，没有发现显著差异。
即使内分泌手术奖学金增加，近四分之一的内分泌手术仍然由单独操作的主治外科医生完成。虽然住院医师/研究员协助的手术时间更长，患者住院时间更长，但在测量结果方面没有显著差异。
