Division of General and Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
J Am Coll Surg. 2013 Jan;216(1):96-104. doi: 10.1016/j.jamcollsurg.2012.08.014. Epub 2012 Sep 19.
The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training.
We queried the NSQIP database for 6 index laparoscopic surgical procedures performed during 2005-2008. Selected procedures require varying skill level (eg, appendectomy, cholecystectomy, gastric bypass, fundoplication, colectomy, and inguinal hernia), and 79,720 cases were identified. Preoperative, operative, and postoperative outcomes for each procedure were tabulated. Operative and postoperative outcomes assessed included operative time, hospital length of stay, mortality, morbidity, and return to the operating room. Initial analysis compared cases done with a resident present with cases done without residents. Subset analysis was done to determine possible differences in outcomes based on the level of resident participating, divided into Junior (PGY1-2), Senior (PGY3-5), or Fellow (PGY>5). Groups were scrutinized for both clinical and statistical differences.
Preoperative characteristics were similar between groups. Operative times were 20% to 47% longer with resident participation, with bigger differences seen in more basic procedures. Mortality and return to the operating room were not clinically different between the groups. Morbidity rates were higher in all procedures with resident participation. More senior residents were associated with longer operative times, without adverse impact on outcomes.
Resident participation increases operative times for laparoscopic surgery considerably. Morbidity is statistically higher with resident participation but differences are unlikely to be clinically significant. Resident participation is a surrogate for the learning environment. These findings provide impetus for additional development of training techniques that occur outside the operating room.
NSQIP 数据库能够测量各种实践环境下的术后结果。这使得人们可以观察到住院医师在培训期间参与外科护理的潜在影响。
我们从 NSQIP 数据库中查询了 2005 年至 2008 年期间进行的 6 项索引腹腔镜手术。所选手术需要不同的技能水平（例如，阑尾切除术、胆囊切除术、胃旁路手术、胃底折叠术、结肠切除术和腹股沟疝修补术），共确定了 79720 例病例。对每种手术的术前、术中和术后结果进行了制表。评估的手术和术后结果包括手术时间、住院时间、死亡率、发病率和返回手术室。初步分析比较了有住院医师参与的病例和没有住院医师参与的病例。进行了亚组分析，以确定根据参与住院医师的水平（初级住院医师[PGY1-2]、高级住院医师[PGY3-5]或研究员[PGY>5]），基于结果可能存在的差异。对各组进行了临床和统计学差异的审查。
各组的术前特征相似。有住院医师参与的手术时间延长了 20%至 47%，在更基础的手术中差异更大。死亡率和返回手术室在组间无临床差异。所有有住院医师参与的手术发病率均较高。更高级别的住院医师与更长的手术时间相关，但对结果没有不利影响。
住院医师的参与显著增加了腹腔镜手术的手术时间。有住院医师参与的手术发病率统计上更高，但差异可能无临床意义。住院医师的参与是学习环境的替代指标。这些发现为开发手术室外的培训技术提供了动力。
