Section of Thoracic Surgery, Columbia University Medical Center, New York, New York.
Ann Thorac Surg. 2013 Dec;96(6):2033-7. doi: 10.1016/j.athoracsur.2013.07.094. Epub 2013 Oct 1.
Thoracic procurements have traditionally been performed by surgical fellows or attending cardiothoracic surgeons. Donor lung procurement protocols are well established and fairly standardized; however, specific procurement training and judgment are essential to optimizing donor utilization. Although the predicted future deficits of cardiothoracic surgeons are based on a variety of analytic models and scenarios, it appears evident that there will not be a sufficient number of trained cardiothoracic surgeons over the next 2 decades. Over the past 5 years in our institution, lung procurements have been performed by a specifically trained physician assistant; as the lead donor surgeon. This model may serve as a cost effective, reproducible, and safe alternative to using surgical fellows and attending surgeons, assuring continuity, ongoing technical expertise, and teaching while addressing future workforce issues as related to transplant.
This is a single institution review of 287 consecutive lung procurements performed by either a physician assistant or fellow over 5 years. This study was approved by the Institutional Review Board of Columbia University, which waived the need for informed consent (IRB#AAAL7107).
From 2008 to 2012, fellows served as senior surgeon in 90 cases (31.4%) versus 197 cases (68.6%) by the physician assistant, including 12 Donations after Cardiac Death and 6 reoperative donors. Injury rate was significantly lower for the physician assistant compared with the resident cohort (1 of 197 [0.5%] vs 22 of 90 [24%], respectively). Rates for pulmonary graft dysfunction grade 2 and 3 were found to be significantly lower in cases where the physician assistant served as senior surgeon (combined rates of 32.2% [29 of 90] vs 9.6% [19 of 197] in the physician assistant group) (p < 0.01).
Use of experienced physician assistants in donor lung procurements is a safe and viable alternative offering continuity of technical expertise and evaluation of lung allografts.
传统上，胸科获取是由外科住院医师或主治心胸外科医生完成的。供肺获取方案已经建立并相当标准化；然而，要优化供体的利用，特定的采购培训和判断是必不可少的。尽管心胸外科医生未来的预测短缺是基于各种分析模型和场景，但显然在未来 20 年内，不会有足够数量的经过培训的心胸外科医生。在我们医院过去的 5 年中，肺的获取是由经过专门培训的医师助理担任首席供体外科医生来完成的。这种模式可以作为使用外科住院医师和主治外科医生的一种具有成本效益、可复制和安全的替代方案，确保连续性、持续的技术专长和教学，同时解决与移植相关的未来劳动力问题。
这是对哥伦比亚大学附属医院 5 年来由医师助理或住院医师进行的 287 例连续肺获取的单机构回顾性研究。该研究得到了哥伦比亚大学机构审查委员会的批准（IRB#AAAL7107），该委员会豁免了知情同意的要求。
2008 年至 2012 年，住院医师担任高级外科医生的病例为 90 例（31.4%），而医师助理担任的病例为 197 例（68.6%），包括 12 例心死亡供者和 6 例再次手术供者。与住院医师组相比，医师助理组的损伤率显著降低（197 例中 1 例[0.5%]与 90 例中 22 例[24%]）。在医师助理担任高级外科医生的情况下，肺移植物功能障碍 2 级和 3 级的发生率显著降低（医师助理组的综合发生率为 32.2%[90 例中的 29 例]与 197 例中的 9.6%[19 例]）（p<0.01）。
在供肺获取中使用经验丰富的医师助理是一种安全可行的替代方案，可以提供技术专长的连续性和肺移植物的评估。
