Wong Teresa Hoi Ian, Guy Gordon, Babidge Wendy, Maddern Guy J
Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2012 Dec;82(12):895-901. doi: 10.1111/j.1445-2197.2012.06310.x. Epub 2012 Oct 24.
In this study, the Australian and New Zealand Audit of Surgical Mortality evaluated the effect of operative supervision on certain post-operative outcomes in the surgical death subset.
This retrospective cohort study was based upon mortality data collected in 2009 which included 1673 patients who died and had surgery within 30 days of death or during the last admission. Cases were divided into three groups: consultant not supervising (group NS), consultant supervising (group S) and consultant performing the operation (group C). A comparison was done nationally and between participating states in Australia. Certain post-operative outcomes were compared between the three groups as well as between elective and emergency operations.
There were significant variations in the levels of operative supervision among states in Australia. Group NS (n = 468) generally had more favourable post-operative outcomes than group S (n = 147) and group C (n = 1058), with post-operative complication rates of 24.8%, 37.4% and 40.9% for groups NS, S and C, respectively. The level of operative supervision in emergency operations was half that of elective operations. Nevertheless, the post-operative complications rate was significantly lower in emergency operations (30.6%) compared with elective operations (64.4%). The same trend was seen with clinical management deficiencies and unplanned return to theatre.
Operative supervision in emergency setting within Australian hospitals appears to be potentially inadequate. However, the available data suggest that unsupervised surgery did not result in worse post-operative outcomes. In appropriately selected cases, the data support surgical registrars performing surgery without consultant supervision.
在本研究中，澳大利亚和新西兰外科手术死亡率审计评估了手术监督对手术死亡亚组中某些术后结果的影响。
这项回顾性队列研究基于2009年收集的死亡率数据，其中包括1673例在死亡后30天内或最后一次住院期间死亡且接受手术的患者。病例分为三组：非监督顾问组（NS组）、监督顾问组（S组）和主刀顾问组（C组）。在全国范围内以及澳大利亚各参与州之间进行了比较。比较了三组之间以及择期手术和急诊手术之间的某些术后结果。
澳大利亚各州的手术监督水平存在显著差异。NS组（n = 468）的术后结果总体上比S组（n = 147）和C组（n = 1058）更有利，NS组、S组和C组的术后并发症发生率分别为24.8%、37.4%和40.9%。急诊手术中的手术监督水平是择期手术的一半。然而，急诊手术的术后并发症发生率（30.6%）明显低于择期手术（64.4%）。临床管理缺陷和计划外重返手术室也呈现相同趋势。
澳大利亚医院急诊环境下的手术监督似乎可能不足。然而，现有数据表明，无监督手术并未导致更差的术后结果。在适当选择的病例中，数据支持外科住院医师在无顾问监督的情况下进行手术。
