Sippey Megan, Spaniolas Konstantinos, Kasten Kevin R
a Department of Surgery , Brody School of Medicine at East Carolina University , Greenville , North Carolina , USA.
b Department of Surgery , Carolinas Health Care System , Charlotte , North Carolina , USA.
J Invest Surg. 2017 Dec;30(6):359-367. doi: 10.1080/08941939.2016.1255805. Epub 2016 Dec 8.
Surgical complications delay adjuvant therapy in oncology patients. Current literature remains unclear regarding resident effect on postoperative outcomes, with inappropriate coverage possibly endangering patients in spite of attending oversight. We assessed resident postgraduate year (PGY) effect on 30-day overall morbidity in cancer patients undergoing major intra-abdominal and non-abdominal surgery.
Patients undergoing non-emergent major intra- and extra-abdominal operations from 2005-2012 were queried using the American College of Surgeons' National Surgical Quality Improvement Program. Attending alone and resident PGY cohorts were compared for demographics, 30-day overall morbidity, mortality, and relevant outcomes.
A total of 156,941 cancer patients undergoing major intra-abdominal (n = 76,385) or major non-abdominal (n = 80,556) procedures were captured. Demographics were clinically similar across attending and PGY levels. Rates of overall morbidity increased significantly with PGY level, along with operative time and length of stay. For major intra-abdominal procedures, all resident levels except PGY2 level adversely affected overall morbidity. Above PGY4 level, resident involvement had a stronger association with adverse outcome than preoperative comorbidities and preoperative chemotherapy. Interestingly, gastric, gall bladder, liver, pancreas, esophageal, and thyroid procedures demonstrated no effect of resident involvement on overall morbidity.
Resident PGY is independently associated with increased overall morbidity in patients undergoing selected major surgical procedures. Understanding surgical procedures affected by resident involvement will maximize outcomes.
手术并发症会延迟肿瘤患者的辅助治疗。目前关于住院医师对术后结果的影响，文献尚无定论，尽管有上级医师监督，但人员配置不当仍可能危及患者。我们评估了住院医师培训阶段（PGY）对接受腹部大手术和非腹部大手术的癌症患者30天总体发病率的影响。
使用美国外科医师学会国家外科质量改进计划，对2005年至2012年接受非急诊腹部内外大手术的患者进行查询。比较仅由上级医师主刀和不同PGY阶段住院医师参与手术的患者的人口统计学特征、30天总体发病率、死亡率及相关结果。
共纳入156,941例接受腹部大手术（n = 76,385）或非腹部大手术（n = 80,556）的癌症患者。不同上级医师和PGY阶段的患者人口统计学特征在临床上相似。总体发病率随PGY阶段升高而显著增加，手术时间和住院时间也随之增加。对于腹部大手术，除PGY2阶段外，所有住院医师阶段均对总体发病率有不利影响。PGY4阶段以上，住院医师参与手术与不良结局的关联比术前合并症和术前化疗更强。有趣的是，胃、胆囊、肝脏、胰腺、食管和甲状腺手术显示住院医师参与手术对总体发病率无影响。
住院医师PGY阶段与接受特定大手术患者的总体发病率增加独立相关。了解受住院医师参与影响的手术操作将使手术效果最大化。
