Baker Andrew B, Ong Adrian A, O'Connell Brendan P, Sokohl Alexander D, Clinkscales William B, Meyer Ted A
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.
Laryngoscope. 2017 Sep;127(9):2026-2032. doi: 10.1002/lary.26645. Epub 2017 May 23.
This study examines the impact of resident physician participation on postoperative outcomes in outpatient otolaryngologic surgery.
Retrospective cohort.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for outpatient otolaryngologic procedures performed on adult patients. Cases were analyzed with the following cohorts: attending with resident or attending without resident. Outcomes included complications, readmission, reoperation, and operative time.
A total of 17,647 cases were analyzed, with 13,123 patients in the attending without resident cohort and 4,524 patients in the attending with resident cohort. The majority of patients were female (58.7%) and white (88.0%). The average age was 44 (range 16-89) years, and average body mass index was 29.0 ± 7.3 kg/m . Total relative value units were higher in the attending with resident group 14.6 ± 12.0 compared with 10.2 ± 8.3 in the attending without resident group (P < 0.01). Univariate analysis revealed that resident participation increased complication rate (2.0% vs. 1.4%, P < 0.01) and operative time (108 ± 98 minutes vs. 60 ± 55 minutes, P < 0.01). There were no differences in readmissions (P = 0.35), reoperations (P > 0.05), or death rates (P = 0.32) between groups. Multivariate regression analysis, however, revealed that resident participation did not increase the rate of any complication, and that operative time was the only significantly impacted variable (P < 0.01).
Resident surgical training remains a vital component of the current health care system. Previous research has shown that, despite increased operative time, resident participation does not significantly impact complication rates for otolaryngology procedures. This study confirms these findings in the outpatient setting, thus reassuring both the surgeon and patients that resident participation does not impact procedural safety.
本研究探讨住院医师参与对门诊耳鼻喉科手术术后结果的影响。
回顾性队列研究。
查询美国外科医师学会国家外科质量改进计划数据库中成年患者的门诊耳鼻喉科手术病例。病例按以下队列进行分析：有住院医师参与的主刀医师组和无住院医师参与的主刀医师组。结果包括并发症、再次入院、再次手术和手术时间。
共分析了17647例病例，无住院医师参与的主刀医师组有13123例患者，有住院医师参与的主刀医师组有4524例患者。大多数患者为女性（58.7%）和白人（88.0%）。平均年龄为44岁（范围16 - 89岁），平均体重指数为29.0±7.3kg/m²。有住院医师参与的主刀医师组的总相对值单位更高，为14.6±12.0，而无住院医师参与的主刀医师组为10.2±8.3（P < 0.01）。单因素分析显示，住院医师参与增加了并发症发生率（2.0%对1.4%，P < 0.01）和手术时间（108±98分钟对60±55分钟，P < 0.01）。两组之间在再次入院率（P = 0.35）、再次手术率（P > 0.05）或死亡率（P = 0.32）方面没有差异。然而，多因素回归分析显示，住院医师参与并未增加任何并发症的发生率，且手术时间是唯一受到显著影响的变量（P < 0.01）。
住院医师外科培训仍然是当前医疗保健系统的重要组成部分。先前的研究表明，尽管手术时间增加，但住院医师参与对耳鼻喉科手术的并发症发生率没有显著影响。本研究在门诊环境中证实了这些发现，从而让外科医生和患者都放心，住院医师参与不会影响手术安全性。
4。《喉镜》，127:2026 - 2032，2017年。
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