Departments of Orthopaedic Surgery (A.I.E. and W.K.H.) and Surgery (F.C.L., S.S., and J.Y.S.K.), Northwestern University, Feinberg School of Medicine, 675 North Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611. E-mail address for J.Y.S. Kim:
J Bone Joint Surg Am. 2014 Aug 6;96(15):e131. doi: 10.2106/JBJS.M.00660.
Operative procedural training is a key component of orthopaedic surgery residency. The influence of intraoperative resident participation on the outcomes of surgery has not been studied extensively using large, population-based databases.
We identified 30,628 patients who underwent orthopaedic procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program. Outcomes as measured by perioperative complications, readmission rates, and mortality within thirty days were compared for cases with and without intraoperative resident involvement.
Logistic regression with propensity score analysis revealed that intraoperative resident participation was associated with decreased rates of overall complications (odds ratio, 0.717 [95% confidence interval, 0.657 to 0.782]), medical complications (odds ratio, 0.723 [95% confidence interval, 0.661 to 0.790]), and mortality (odds ratio, 0.638 [95% confidence interval, 0.427 to 0.951]). Resident presence in the operating room was not predictive of wound complications (odds ratio, 0.831 [95% confidence interval, 0.656 to 1.053]), readmission (odds ratio, 0.962 [95% confidence interval, 0.830 to 1.116]), or reoperation (odds ratio, 0.938 [95% confidence interval, 0.758 to 1.161]). A second analysis by propensity score stratification into quintiles grouped by similar probability of intraoperative resident presence showed resident involvement to correlate with decreased rates of overall and medical complications in three quintiles, but increased rates of overall and medical complications in one quintile. All other outcomes were equivalent across quintiles.
Orthopaedic resident involvement during surgical procedures is associated with lower risk of perioperative complications and mortality in the National Surgical Quality Improvement Program database. The results support resident participation in the operative care of orthopaedic patients.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
手术操作程序培训是骨科住院医师培训的一个关键组成部分。然而，使用大型基于人群的数据库广泛研究术中住院医师参与对手术结果的影响还很少。
我们从 2011 年美国外科医师学会国家手术质量改进计划中确定了 30628 例接受骨科手术的患者。比较了有和没有术中住院医师参与的病例在围手术期并发症、再入院率和 30 天内死亡率等方面的结果。
使用倾向评分分析的逻辑回归显示，术中住院医师参与与总体并发症发生率降低相关（比值比，0.717[95%置信区间，0.657 至 0.782]）、医疗并发症发生率降低（比值比，0.723[95%置信区间，0.661 至 0.790]）和死亡率降低（比值比，0.638[95%置信区间，0.427 至 0.951]）。手术室中住院医师的存在与伤口并发症（比值比，0.831[95%置信区间，0.656 至 1.053]）、再入院（比值比，0.962[95%置信区间，0.830 至 1.116]）或再次手术（比值比，0.938[95%置信区间，0.758 至 1.161]）无关。通过倾向评分分层成类似术中住院医师存在概率的五分位数进行的二次分析显示，在三个五分位数中，住院医师的参与与总体和医疗并发症发生率降低相关，但在一个五分位数中，与总体和医疗并发症发生率增加相关。所有其他结果在五分位数之间是等效的。
在国家手术质量改进计划数据库中，骨科住院医师参与手术与围手术期并发症和死亡率风险降低相关。结果支持住院医师参与骨科患者的手术治疗。
治疗性 III 级。有关证据水平的完整描述，请参见作者指南。
