Undurraga Perl Vicente, Diggs Brian, Ham Bruce, Schreiber Martin
Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
Am J Surg. 2015 May;209(5):828-32; discussion 832-3. doi: 10.1016/j.amjsurg.2015.01.006. Epub 2015 Feb 17.
Operations performed by surgeons working at Critical Access Hospitals (CAHs) and surgery residents have not been compared.
Procedure codes logged by general surgery residents graduating from our institution in 2013 and 2014 were obtained. Procedure codes were obtained for all CAHs in our state for 2012 to 2013. Clinically relevant categories were compared among residents and general surgeons at CAHs.
A total of 34,246 procedures logged by general surgeons at CAHs were compared with 31,977 procedures logged by surgery residents. Endoscopy comprised 56.1% of cases done by general surgeons versus 9.1% of cases by residents (P < .001). Excluding endoscopy, rural surgeons had higher percentages in hernia, skin/soft tissue, cholecystectomy/common bile duct, rectal/anal, and breast cases. Residents who completed a rural surgery rotation had higher numbers in small/large bowel, hernia, breast, and endoscopy.
Surgery residency provides less exposure to endoscopy compared with a general surgery practice at CAHs. A rural rotation increases endoscopic exposure.
尚未对在临界接入医院（CAH）工作的外科医生与外科住院医师所实施的手术进行比较。
获取了我校2013年和2014年毕业的普通外科住院医师记录的手术编码。获取了本州所有CAH在2012年至2013年的手术编码。对住院医师和CAH的普通外科医生之间的临床相关类别进行了比较。
将CAH的普通外科医生记录的总共34,246例手术与外科住院医师记录的31,977例手术进行了比较。内镜检查占普通外科医生所做病例的56.1%，而住院医师所做病例的比例为9.1%（P <.001）。排除内镜检查后，乡村外科医生在疝气、皮肤/软组织、胆囊切除术/胆总管、直肠/肛门和乳腺病例中的比例更高。完成乡村外科轮转的住院医师在小肠/大肠、疝气、乳腺和内镜检查方面的手术例数更多。
与CAH的普通外科实践相比，外科住院医师培训中接触内镜检查的机会较少。乡村轮转增加了内镜检查的接触机会。
