Nüssler Emil, Eskildsen Jacob Kjær, Nüssler Emil Karl, Bixo Marie, Löfgren Mats
Department of Clinical Science, Obstetrics and Gynecology, Umeå University, 90187, Umeå, Sweden.
Department of Management, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.
Int Urogynecol J. 2018 Feb;29(2):297-306. doi: 10.1007/s00192-017-3353-0. Epub 2017 Jun 2.
Surgical work encompasses important aspects of personal and manual skills. In major surgery, there is a positive correlation between surgical experience and results. For pelvic organ prolapse (POP), this relationship has to our knowledge never been examined. In any clinical practice, there is always a certain proportion of inexperienced surgeons. In Sweden, most prolapse surgeons have little experience in performing prolapse operations, 74% conducting the procedure once a month or less. Simultaneously, surgery for POP globally has failure rates of 25-30%. In other words, for most surgeons, the operation is a low-frequency procedure, and outcomes are unsatisfactory. The aim of this study was to clarify the acceptability of having a high proportion of low-volume surgeons in the management of POP.
A group of 14,676 exclusively primary anterior or posterior repair patients was assessed. Data were analyzed by logistic regression and as a group analysis.
Experienced surgeons had shorter operation times and hospital stays. Surgical experience did not affect surgical or patient-reported complication rates, organ damage, reoperation, rehospitalization, or patient satisfaction, nor did it improve patient-reported failure rates 1 year after surgery. Assistant experience, similarly, had no effect on the outcome of the operation.
A management model for isolated anterior or posterior POP surgery that includes a high proportion of low-volume surgeons does not have a negative impact on the quality or outcome of anterior or posterior colporrhaphy. Consequently, the high recurrence rate was not due to insufficient experience of the surgeons performing the operation.
外科手术工作涵盖个人技能和手工技能的重要方面。在大型手术中，手术经验与手术结果呈正相关。就盆腔器官脱垂（POP）而言，据我们所知，这种关系从未被研究过。在任何临床实践中，总会有一定比例的经验不足的外科医生。在瑞典，大多数脱垂外科医生在进行脱垂手术方面经验不足，74%的医生每月进行该手术一次或更少。同时，全球范围内POP手术的失败率为25% - 30%。换句话说，对大多数外科医生来说，该手术是一种低频率手术，且结果不尽人意。本研究的目的是阐明在POP管理中有高比例低手术量外科医生的可接受性。
对一组14676例单纯原发性前壁或后壁修复患者进行评估。通过逻辑回归和分组分析对数据进行分析。
经验丰富的外科医生手术时间和住院时间较短。手术经验并未影响手术或患者报告的并发症发生率、器官损伤、再次手术、再次住院或患者满意度，也未改善患者报告的术后1年失败率。同样，助手的经验对手术结果也没有影响。
一种孤立性前壁或后壁POP手术的管理模式，其中包括高比例的低手术量外科医生，对前壁或后壁阴道修补术的质量或结果没有负面影响。因此，高复发率并非由于进行手术的外科医生经验不足所致。
