Surgical Health Outcomes & Research Enterprise, University of Rochester Medical Center, Rochester, NY 14642, USA.
J Vasc Surg. 2013 Sep;58(3):827-31.e1. doi: 10.1016/j.jvs.2013.04.046. Epub 2013 Jun 14.
Despite the recent major changes in vascular and general surgery training, there has been a paucity of literature examining the effect of these changes on training and surgical outcomes. Amputations represent a common cross-section in core competencies for general surgery and vascular surgery trainees. This study evaluates the effect of trainee participation on outcomes after above-knee and below-knee amputations.
The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database (2005 to 2010) was queried using Current Procedural Terminology codes (American Medical Association, Chicago, Ill) for below-knee amputation (27880, 27882) and above knee-amputation (27590, 27592). Resident involvement was defined using the NSQIP variable and was narrowed to postgraduate year 1 to 5. Variables associated with resident involvement were identified, and mortality, morbidity, intraoperative transfusion, and operative time (75th percentile vs the bottom three quartiles) were evaluated as distinct categoric end points in logistic regression. Included in the model were variables with a P value <.1 on χ(2) or independent t-test, as appropriate. Significance was defined at P < .05.
Residents were involved in 6587 of 11,038 amputations (62%). After adjustment for preoperative and intraoperative factors on logistic regression, there was a significant increase in major morbidity (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.14-1.42; P < .001), intraoperative transfusion (OR, 1.78; 95% CI, 1.50-2.11; P < .001), and operative time (OR, 1.64 95% CI, 1.46-1.84; P < .001) in resident cases.
Resident involvement was associated with increased odds of major morbidity after amputation and also with increased operative time and risk for intraoperative transfusions.
尽管血管和普通外科培训最近发生了重大变化，但很少有文献研究这些变化对培训和手术结果的影响。截肢是普通外科和血管外科受训者核心能力的常见交叉点。本研究评估了受训者参与对膝上和膝下截肢术后结果的影响。
使用美国外科医师学会-国家外科质量改进计划（NSQIP）数据库（2005 年至 2010 年），通过当前程序术语代码（芝加哥美国医学协会）查询膝下截肢（27880、27882）和膝上截肢（27590、27592）。住院医师参与的定义使用 NSQIP 变量，并缩小到住院医师的第 1 至 5 年。确定与住院医师参与相关的变量，并将死亡率、发病率、术中输血和手术时间（第 75 百分位数与底部三个四分位数）作为逻辑回归中的不同分类终点进行评估。模型中包括在 χ(2)或独立 t 检验中 P 值<.1 的变量，视情况而定。定义显著性水平为 P<.05。
在 11038 例截肢术中，有 6587 例（62%）涉及住院医师。在校正逻辑回归中的术前和术中因素后，主要发病率（比值比 [OR]，1.27；95%置信区间 [CI]，1.14-1.42；P<.001）、术中输血（OR，1.78；95% CI，1.50-2.11；P<.001）和手术时间（OR，1.64 95% CI，1.46-1.84；P<.001）在住院医师病例中显著增加。
住院医师的参与与截肢术后主要发病率的几率增加以及手术时间延长和术中输血风险增加有关。
