Andersen Morten Jon, Gromov Kiril, Brix Michael, Troelsen Anders
Ortopædkirurgisk Afdeling, Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark.
Dan Med J. 2014 Jun;61(6):A4839.
The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours.
A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Müller), and whether they were performed during or outside regular hours.
Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries by interns were performed under supervision, whereas 32% of operations by junior residents were unsupervised. Supervision was absent in 14-16% and 22-33% of the three most frequent primary procedures and reoperations when performed by interns and junior residents, respectively. The proportion of unsupervised procedures by junior residents grew from 30% during to 40% (p < 0.001) outside regular hours.
Interns and junior residents together performed almost half of all fracture-related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior residents were unsupervised. The extent of unsupervised surgery performed by junior residents was significantly higher outside regular hours.
not relevant.
The Danish Fracture Database ("Dansk Frakturdatabase") was approved by the Danish Data Protection Agency ID: 01321.
在髋部骨折手术和关节置换手术中，均已证明监督及外科医生的经验水平与患者预后相关。本研究的目的是描述外科医生的经验水平以及在以下方面的监督程度：1）一般骨折相关手术；2）三种最常见的初次手术和再次手术；3）正常工作时间内及之外的初次手术。
从丹麦骨折数据库（DFDB）中识别出总共9767例外科手术。手术根据外科医生的经验水平、监督程度、类型（初次、计划二次或再次手术）、分类（AO Müller）以及手术是在正常工作时间内还是之外进行分组。
实习医生和低年资住院医师共完成了所有手术的46%。实习医生进行的手术中，90%是在监督下完成的，而低年资住院医师进行的手术中有32%是无人监督的。实习医生和低年资住院医师分别进行的三种最常见的初次手术和再次手术中，无监督的比例分别为14 - 16%和22 - 33%。低年资住院医师无人监督的手术比例从正常工作时间内的30%增加到正常工作时间之外的40%（p < 0.001）。
实习医生和低年资住院医师共同完成了几乎一半的骨折相关手术。监督程度总体较高；然而，低年资住院医师进行的初次手术中有三分之一是无人监督的。低年资住院医师在正常工作时间之外进行的无人监督手术的比例明显更高。
不相关。
丹麦骨折数据库（“Dansk Frakturdatabase”）已获得丹麦数据保护局批准，ID：01321。
