住院医师作为教学助手对腹腔镜胆囊切除术手术时间的影响。
The effect of residents as teaching assistants on operative time in laparoscopic cholecystectomy.
作者信息
Gifford Edward, Kim Dennis Y, Nguyen Andrew, Kaji Amy H, Nguyen Virginia, Plurad David S, de Virgilio Christian
机构信息
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA.
Harbor-UCLA Medical Center, Torrance, CA, USA.
出版信息
Am J Surg. 2016 Jan;211(1):288-93. doi: 10.1016/j.amjsurg.2015.06.019. Epub 2015 Aug 12.
BACKGROUND
We examined the effect of primary surgeon (PS) and teaching assistant (TA) seniority on operative time and outcomes for residents performing laparoscopic cholecystectomy (LC).
METHODS
This was a retrospective analysis of urgent LC at a county teaching hospital. Relevant data included postgraduate year (PGY) of the PS and TA and markers of disease severity. Primary outcome was operative time. Secondary outcomes were conversion to open cholecystectomy and complications.
RESULTS
There were 1,202 LCs; 415 included an intraoperative cholangiogram. On multivariable analysis, every PGY increase of PS decreased operative time by 3.2 minutes (P = .02). For every PGY increase of TA, operative time decreased 10.8 minutes (P < .001). Acute or gangrenous pathology increased conversion to open surgery (P < .001). Seniority of PS and TA was not associated with increases in conversion or complication rates.
CONCLUSIONS
Residents' operative time improves as experience with LC increases. These improvements become more profound after adjusting for the seniority of the TA.
背景
我们研究了主刀医生（PS）和带教助手（TA）的资历对住院医师进行腹腔镜胆囊切除术（LC）的手术时间及手术结果的影响。
方法
这是一项针对某县教学医院急诊LC的回顾性分析。相关数据包括PS和TA的研究生年级（PGY）以及疾病严重程度指标。主要结局为手术时间。次要结局为转为开腹胆囊切除术及并发症。
结果
共进行了1202例LC手术；其中415例术中进行了胆管造影。多变量分析显示，PS的PGY每增加一级，手术时间减少3.2分钟（P = 0.02）。TA的PGY每增加一级，手术时间减少10.8分钟（P < 0.001）。急性或坏疽性病变会增加转为开腹手术的几率（P < 0.001）。PS和TA的资历与转为开腹手术率或并发症发生率的增加无关。
结论
随着LC经验的增加，住院医师的手术时间会缩短。在调整TA的资历后，这些改善更为显著。
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