Aviki Emeline M, Rauh-Hain J Alejandro, Clark Rachel M, Hall Tracilyn R, Berkowitz Lori R, Boruta David M, Growdon Whitfield B, Schorge John O, Goodman Annekathryn
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Department of Obstetrics and Gynecology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
Gynecol Oncol. 2015 Apr;137(1):93-7. doi: 10.1016/j.ygyno.2015.01.536. Epub 2015 Jan 21.
The aim of this study is to explore the previously unexamined role of the Gynecologic Oncologist as an intraoperative consultant during general gynecologic surgery.
Demographic and clinical data were collected on 98 major gynecologic surgeries that included both a general Gynecologist and a Gynecologic Oncologist between October 2010 and August 2014. Data were analyzed using XLSTAT-Prov2014.2.02.
Of 794 major gynecologic surgeries, 98 (12.3%) cases that involved an intraoperative consultation were identified. There were 36 (37%) planned consults and 62 (63%) unplanned consults. Significantly more planned consults were during laparoscopy (100% v 58%; p<0.01) and significantly more unplanned consults were during laparotomy (42% v 0%; p<0.01). The majority of planned consults were for surgical training (86%) and the most common reasons for unplanned consults were adhesions (40%), bowel injury (19%), inability to identify ureter (19%), and cancer (11%). The most common interventions performed during unplanned consults were identification of anatomy (55%), lysis of adhesions (42%), and retroperitoneal dissection (27%). Average surgeon years in practice were significantly lower for unplanned consults (9 v 15; p<0.01). A total of 25 major adverse events occurred in 15 cases with the majority occurring in cases with unplanned consults (23% v 3%; p<0.01). After controlling for laparotomy, unplanned consultation was not significantly associated with major events (OR=6.67, 95%CI 0.69-64.39; p=0.10).
Gynecologic Oncologists play a pivotal role in the support of generalist colleagues during pelvic surgery. In this series, Gynecologic Oncologists were consulted frequently for complex major benign surgeries. It is important to incorporate the skills required of an intraoperative consultant into Gynecologic Oncology fellowship training.
本研究旨在探讨妇科肿瘤学家在普通妇科手术中作为术中顾问这一此前未被研究的角色。
收集了2010年10月至2014年8月期间98例主要妇科手术的人口统计学和临床数据，这些手术涉及一名普通妇科医生和一名妇科肿瘤学家。使用XLSTAT - Prov2014.2.02对数据进行分析。
在794例主要妇科手术中，识别出98例（12.3%）涉及术中会诊的病例。其中有36例（37%）是计划内会诊，62例（63%）是计划外会诊。计划内会诊在腹腔镜手术期间显著更多（100%对58%；p<0.01），计划外会诊在剖腹手术期间显著更多（42%对0%；p<0.01）。大多数计划内会诊是为了手术培训（86%），计划外会诊最常见的原因是粘连（40%）、肠损伤（19%）、无法识别输尿管（19%）和癌症（11%）。计划外会诊期间最常见的干预措施是识别解剖结构（55%）、粘连松解（42%）和腹膜后解剖（27%）。计划外会诊的外科医生平均执业年限显著更低（9年对15年；p<0.01）。15例病例中总共发生了25起严重不良事件，大多数发生在计划外会诊的病例中（分别为23%和3%；p<0.01）。在控制了剖腹手术因素后，计划外会诊与严重事件无显著相关性（OR = 6.67，95%CI 0.69 - 64.39；p = 0.10）。
妇科肿瘤学家在盆腔手术中对普通妇科同事的支持方面发挥着关键作用。在本系列研究中，妇科肿瘤学家经常就复杂的重大良性手术进行会诊。将术中顾问所需技能纳入妇科肿瘤学专科培训很重要。
