Department of Surgery, University of Arizona, Tucson, Arizona.
Department of Surgery, University of Arizona, Tucson, Arizona.
J Surg Res. 2014 Aug;190(2):559-64. doi: 10.1016/j.jss.2014.05.025. Epub 2014 May 20.
The changing paradigm of surgical residency training has raised concerns about the effects on the quality of training. The purpose of this study is to identify if resident participation in laparoscopic adrenalectomy (LA) and open adrenalectomy (OA) cases is associated with deleterious outcomes.
This is a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. Data from patients undergoing LA and OA from 2005 to 2010 were queried. Preoperative variables as well as intra- and post-operative outcomes for each procedure were evaluated. Multivariate logistic regression was used to analyze if resident participation was associated with significant differences in outcomes, compared with no resident participation. Subset analysis was done to determine possible differences in outcomes based on the level of resident participating, divided into junior (Post Graduate Year [PGY]1-3), senior (PGY4-5), or fellow (≥PGY6) levels.
A total of 3219 adrenalectomies were performed. Of these, 735 (22.8%) were OAs and 2484 (77.2%) were LAs. Residents were involved in 2582 (80.2%) surgeries, which comprised 1985 (76.9%) LAs and 597 (23.1%) OAs. Senior residents or fellows performed majority of the cases (85.2%). Mean operative time was significantly higher with resident participation in LA (P < 0.0001) and OA group (P < 0.0001). On multivariate analysis, resident participation was not associated with significant differences in the operative outcomes of 30-d mortality or postoperative complications after laparoscopic or OA.
Although resident participation does increase operative time in LA and OA, this does not appear to be clinically significant and does not result in adverse patient outcomes.
外科住院医师培训模式的转变引发了人们对培训质量的担忧。本研究旨在确定住院医师参与腹腔镜肾上腺切除术（LA）和开放肾上腺切除术（OA）是否与不良结局相关。
这是一项使用美国外科医师学院国家手术质量改进计划数据库的回顾性研究。从 2005 年至 2010 年，对接受 LA 和 OA 的患者进行了数据查询。评估了每种手术的术前变量以及术中、术后结果。使用多变量逻辑回归分析了与无住院医师参与相比，住院医师参与是否与结果的显著差异相关。进行了亚组分析，以确定根据住院医师参与的级别（住院医师 1-3 年[PGY1-3]、住院医师 4-5 年[PGY4-5]或研究员[≥PGY6]），在结局上可能存在的差异。
共进行了 3219 例肾上腺切除术。其中，735 例（22.8%）为 OA，2484 例（77.2%）为 LA。住院医师参与了 2582 例手术（80.2%），其中包括 1985 例 LA（76.9%）和 597 例 OA（23.1%）。高年住院医师或研究员完成了大多数病例（85.2%）。LA 和 OA 组中，有住院医师参与时的手术时间明显较长（P<0.0001）。多变量分析显示，在腹腔镜或 OA 后 30 天死亡率或术后并发症方面，住院医师参与与手术结局无显著差异。
尽管住院医师参与确实会增加 LA 和 OA 的手术时间，但这似乎并没有临床意义，也不会导致患者的不良结局。
