Clin Orthop Relat Res. 2014 Jul;472(7):2290-300. doi: 10.1007/s11999-014-3567-0.
The influence of resident involvement on short-term outcomes after orthopaedic surgery is mostly unknown.
QUESTIONS/PURPOSES: The purposes of our study were to examine the effects of resident involvement in surgical cases on short-term morbidity, mortality, operating time, hospital length of stay, and reoperation rate and to analyze these parameters by level of training.
The 2005–2011 American College of Surgeons National Surgical Quality Improvement Program data set was queried using Current Procedural Terminology codes for 66,817 cases across six orthopaedic procedural domains: 28,686 primary total joint arthroplasties (TJAs), 2412 revision TJAs, 16,832 basic and 5916 advanced arthroscopies, 8221 lower extremity traumas, and 4750 spine arthrodeses (fusions). Bivariate and multivariate logistic regression and propensity scores were used to build models of risk adjustment. We compared the morbidity and mortality rates, length of operating time, hospital length of stay, and reoperation rate for cases with or without resident involvement. For cases with resident participation, we analyzed the same parameters by training level.
Resident participation was associated with higher morbidity in TJAs (odds ratio [OR], 1.6; range, 1.4–1.9), lower extremity trauma (OR, 1.3; range, 1.2–1.5), and fusion (OR, 1.4; range, 1.2–1.7) after adjustment. However, resident involvement was not associated with increased mortality. Operative time was greater (all p < 0.001) with resident involvement in all procedural domains. Longer hospital length of stay was associated with resident participation in lower extremity trauma (p < 0.001) and fusion cases (p = 0.003), but resident participation did not affect length of stay in other domains. Resident involvement was associated with greater 30-day reoperation rates for cases of lower extremity trauma (p = 0.041) and fusion (p < 0.001). Level of resident training did not consistently influence surgical outcomes.
Results of our study suggest resident involvement in surgical procedures is not associated with increased short-term major morbidity and mortality after select cases in orthopaedic surgery. Findings of longer operating times and differences in minor morbidity should lead to future initiatives to provide resident surgical skills training and improve perioperative efficiency in the academic setting.
Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
住院医师参与对骨科手术后短期结果的影响尚不清楚。
问题/目的：我们研究的目的是检查住院医师参与手术对短期发病率、死亡率、手术时间、住院时间和再次手术率的影响，并按培训水平分析这些参数。
使用美国外科医师学院国家手术质量改进计划 2005-2011 年数据集，通过当前操作术语代码查询六个骨科操作领域的 66817 例：28686 例原发性全关节置换术（TJA）、2412 例翻修 TJA、16832 例基本和 5916 例高级关节镜检查、8221 例下肢创伤和 4750 例脊柱融合术。使用二变量和多变量逻辑回归和倾向评分建立风险调整模型。我们比较了有或没有住院医师参与的病例的发病率和死亡率、手术时间、住院时间和再次手术率。对于有住院医师参与的病例，我们按培训水平分析了相同的参数。
调整后，住院医师参与与 TJA（比值比[OR]，1.6；范围，1.4-1.9）、下肢创伤（OR，1.3；范围，1.2-1.5）和融合（OR，1.4；范围，1.2-1.7）的发病率更高相关。然而，住院医师参与与死亡率增加无关。所有手术领域的住院医师参与都会导致手术时间延长（所有 p < 0.001）。住院时间延长与下肢创伤（p < 0.001）和融合病例（p = 0.003）中的住院医师参与有关，但住院医师参与对其他领域的住院时间没有影响。住院医师参与与下肢创伤（p = 0.041）和融合（p < 0.001）病例的 30 天再手术率增加有关。住院医师培训水平并未始终影响手术结果。
我们的研究结果表明，在选择的骨科手术后病例中，住院医师参与手术与短期主要发病率和死亡率增加无关。手术时间延长和轻微发病率差异的发现应促使未来采取措施提供住院医师手术技能培训，并提高学术环境下的围手术期效率。
II 级，预后研究。有关证据水平的完整描述，请参阅作者说明。
