Division of General Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR, USA.
Surg Endosc. 2011 Jun;25(6):1969-74. doi: 10.1007/s00464-010-1495-y. Epub 2010 Dec 7.
Laparoscopic cholecystectomy (LC) is a common surgical procedure performed by surgical residents under the supervision of attending surgeons. There is a perception that performance of LC in a facility with a surgical training program provides a safer environment due to the presence of an assistant surgeon. The aim of this study was to compare the rate of bile duct injury, conversion, and mortality between hospitals with surgical residency programs (Group I) and hospitals without surgical training programs (Group II).
ICD-9 diagnosis and procedure codes were used to extract and analyze LC procedures from the Florida State Inpatient Database from 1997 through 2006. Bile duct injury was indicated by the code for a biliary reconstruction procedure performed during the same admission. Hospitals with surgical training programs were identified by participation in the Electronic Residency Application Service (ERAS) and verified by contact with each hospital.
Between 1997 and 2006 there were 234,220 LCs identified, with 17,596 performed by Group I and 213,906 performed by Group II. Rate of BDI for Group I and Group II was 0.24 and 0.26%, respectively (p=0.71). There was a significant difference noted in emergency and urgent admission rates (65.6% for Group I vs. 77.2% for Group II; p<0.001) and conversion (9.1% for Group I vs. 7.5% for Group II; p<0.001). Mortality was 0.44% for Group I and 0.55% for Group II (p=0.060).
Our data suggest that bile duct injury rates are not influenced by the presence of a surgical residency program. In addition, there was no significant difference in mortality for LC at hospitals with surgical residencies when compared to hospitals without surgical residencies. A significant difference was noted in admission type and conversion rate but this did not appear to affect the rate of bile duct injury.
腹腔镜胆囊切除术（LC）是一种常见的手术程序，由外科住院医师在主治外科医生的监督下进行。人们认为，在有外科培训计划的设施中进行 LC 手术由于有辅助外科医生的存在，因此环境更安全。本研究的目的是比较有外科住院医师培训计划的医院（I 组）和没有外科培训计划的医院（II 组）之间胆管损伤、中转开腹和死亡率的发生率。
使用 ICD-9 诊断和手术代码从 1997 年至 2006 年从佛罗里达州住院患者数据库中提取并分析 LC 手术。同一住院期间进行胆道重建手术的代码表示胆管损伤。通过参与电子住院医师申请服务（ERAS）确定有外科住院医师培训计划的医院，并通过与每家医院联系进行验证。
在 1997 年至 2006 年间，共确定了 234220 例 LC 手术，其中 I 组进行了 17596 例，II 组进行了 213906 例。I 组和 II 组的 BDI 发生率分别为 0.24%和 0.26%（p=0.71）。I 组和 II 组的急诊和紧急入院率（I 组为 65.6%，II 组为 77.2%；p<0.001）和中转开腹率（I 组为 9.1%，II 组为 7.5%；p<0.001）有显著差异。I 组和 II 组的死亡率分别为 0.44%和 0.55%（p=0.060）。
我们的数据表明，胆管损伤发生率不受外科住院医师培训计划的影响。此外，与没有外科住院医师的医院相比，有外科住院医师的医院进行 LC 手术的死亡率没有显著差异。入院类型和中转开腹率有显著差异，但这似乎并未影响胆管损伤的发生率。
