Bydon Mohamad, Abt Nicholas B, De la Garza-Ramos Rafael, Macki Mohamed, Witham Timothy F, Gokaslan Ziya L, Bydon Ali, Huang Judy
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Neurosurg. 2015 Apr;122(4):955-61. doi: 10.3171/2014.11.JNS14890. Epub 2015 Jan 9.
The authors sought to determine the impact of resident participation on overall 30-day morbidity and mortality following neurosurgical procedures.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who had undergone neurosurgical procedures between 2006 and 2012. The operating surgeon(s), whether an attending only or attending plus resident, was assessed for his or her influence on morbidity and mortality. Multivariate logistic regression, was used to estimate odds ratios for 30-day postoperative morbidity and mortality outcomes for the attending-only compared with the attending plus resident cohorts (attending group and attending+resident group, respectively).
The study population consisted of 16,098 patients who had undergone elective or emergent neurosurgical procedures. The mean patient age was 56.8 ± 15.0 years, and 49.8% of patients were women. Overall, 15.8% of all patients had at least one postoperative complication. The attending+resident group demonstrated a complication rate of 20.12%, while patients with an attending-only surgeon had a statistically significantly lower complication rate at 11.70% (p < 0.001). In the total population, 263 patients (1.63%) died within 30 days of surgery. Stratified by operating surgeon status, 162 patients (2.07%) in the attending+resident group died versus 101 (1.22%) in the attending group, which was statistically significant (p < 0.001). Regression analyses compared patients who had resident participation to those with only attending surgeons, the referent group. Following adjustment for preoperative patient characteristics and comorbidities, multivariate regression analysis demonstrated that patients with resident participation in their surgery had the same odds of 30-day morbidity (OR = 1.05, 95% CI 0.94-1.17) and mortality (OR = 0.92, 95% CI 0.66-1.28) as their attending only counterparts.
Cases with resident participation had higher rates of mortality and morbidity; however, these cases also involved patients with more comorbidities initially. On multivariate analysis, resident participation was not an independent risk factor for postoperative 30-day morbidity or mortality following elective or emergent neurosurgical procedures.
作者试图确定住院医师参与对神经外科手术后30天总体发病率和死亡率的影响。
查询美国外科医师学会国家外科质量改进计划数据库中2006年至2012年间接受神经外科手术的所有患者。评估主刀医生（无论是仅由主治医生还是由主治医生加住院医师）对发病率和死亡率的影响。使用多因素逻辑回归来估计仅由主治医生手术的患者与由主治医生加住院医师手术的患者（分别为主治医生组和主治医生+住院医师组）术后30天发病率和死亡率结果的比值比。
研究人群包括16,098例接受择期或急诊神经外科手术的患者。患者平均年龄为56.8±15.0岁，49.8%为女性。总体而言，15.8%的患者至少有一项术后并发症。主治医生+住院医师组的并发症发生率为20.12%，而仅由主治医生手术的患者并发症发生率在统计学上显著较低，为11.70%（p<0.001）。在总人群中，263例患者（1.63%）在术后30天内死亡。按主刀医生状态分层，主治医生+住院医师组中有162例患者（2.07%）死亡，而主治医生组中有101例患者（1.22%）死亡，差异具有统计学意义（p<0.001）。回归分析将有住院医师参与手术的患者与仅由主治医生手术的患者（作为参照组）进行比较。在对术前患者特征和合并症进行调整后，多因素回归分析表明，有住院医师参与手术的患者术后30天发病率（OR=1.05，95%CI 0.94-1.17）和死亡率（OR=0.92，95%CI 0.66-1.28）与仅由主治医生手术的患者相同。
有住院医师参与的病例死亡率和发病率较高；然而，这些病例最初也涉及更多合并症的患者。在多因素分析中，住院医师参与并非择期或急诊神经外科手术后30天发病率或死亡率的独立危险因素。
