Department of Surgery, Harbor UCLA Medical Center, Torrance, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California.
J Surg Educ. 2013 Nov-Dec;70(6):796-9. doi: 10.1016/j.jsurg.2013.09.011.
The resident as teaching assistant (TA) in the operating room is an important role in the maturation of surgical trainees. One concern in the current 80-hour workweek era is that current senior residents (SRs) are unprepared to serve as TAs, potentially leading to higher complication rates and a significant increase in the length of operations. The aim of this study was to analyze whether SRs serving as TAs during laparoscopic cholecystectomy (LC) resulted in an adverse effect on complication rates in the 80-hour workweek era.
A retrospective review was conducted of 1668 LC performed at 2 affiliated general surgery teaching hospitals from 2003 through 2007. Teaching hospital A was a public teaching hospital where junior residents (JR) performed the LC with a scrubbed SR as TA under faculty supervision. Teaching hospital B was a community-based affiliate hospital where the JR performed LC with only scrubbed faculty supervision. Operative case duration, JR level, patient gender/age, operative indication, final pathology, and complication data were gathered and univariate and multivariate analyses were performed.
Despite a higher rate of acute cholecystitis in the TA hospital, LC-associated complications occurred at similar rates with and without SR as TA. The rate of biliary injury was also the same in both hospitals. On multivariable analysis, only male gender was associated with complications (odds ratio = 1.7; p = 0.004).
In the 80-hour resident workweek era, SRs acting as TAs during LC is not associated with increased total complications or an increased rate of biliary injury.
住院医师作为手术室教学助理（TA）是外科受训者成熟的重要角色。在当前 80 小时工作周时代，一个关注的问题是，当前的高级住院医师（SR）没有准备好担任 TA，这可能导致更高的并发症发生率和手术时间的显著增加。本研究旨在分析在腹腔镜胆囊切除术（LC）中，SR 担任 TA 是否会对 80 小时工作周时代的并发症发生率产生不利影响。
回顾性分析了 2003 年至 2007 年在 2 家附属普通外科教学医院进行的 1668 例 LC。教学医院 A 是一家公立医院，初级住院医师（JR）在带教 SR 的情况下进行 LC，SR 担任 TA，并在教员监督下进行。教学医院 B 是一家社区附属医院，JR 在只有带教教员监督的情况下进行 LC。收集了手术持续时间、JR 级别、患者性别/年龄、手术指征、最终病理和并发症数据，并进行了单变量和多变量分析。
尽管 TA 医院的急性胆囊炎发生率较高，但有和没有 SR 担任 TA 的 LC 相关并发症发生率相似。两家医院的胆管损伤发生率也相同。多变量分析显示，只有男性性别与并发症相关（比值比=1.7；p=0.004）。
在 80 小时住院医师工作周时代，SR 担任 LC 的 TA 不会增加总并发症或胆管损伤的发生率。
