Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California.
Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.
J Surg Educ. 2017 Nov-Dec;74(6):1124-1132. doi: 10.1016/j.jsurg.2017.05.017. Epub 2017 Jun 9.
In the current healthcare climate, there is increased focus on medical errors, patient outcomes, and the influence of resident participation on these metrics. Other studies have examined the influence of resident involvement on surgical outcomes, but the arena of microsurgery, with added complexity and learning curve, has yet to be investigated.
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed to find patients undergoing procedures with free tissue transfer by screening for Current Procedural Terminology codes. Primary outcomes measured include flap failure, wound, infectious, and major and minor complications.
This study was conducted at the Methodist Hospital, an academic hospital located in Houston, Texas.
Patients in the National Surgical Quality Improvement Program database between the years 2005 and 2012 undergoing microsurgical procedures were included in this analysis.
A total of 1466 patients met inclusion criteria. There was a statistically significant association of major complications with age, peripheral vascular disease, American Society of Anesthesiologists (ASA) classification of 3 or greater, total operative time, and year of operation. Multivariate analysis on minor complications demonstrated significant association with ASA class of 3 or 4. Resident involvement was not a significant factor among any outcome measures including major complications, minor complications, flap failure, wound complications, infectious complications, bleeding requiring transfusion, and unexpected reoperation rates within 30 days.
This study provides further evidence in support of the claim that resident involvement in microsurgery is safe and effective, with similar rates of major complications, minor complications, flap failure, and unexpected reoperation. High ASA classification and history of peripheral vascular disease were strong predictors of major complications and should be optimized preoperatively before free tissue transfer. Later years were associated with decreased major complication rates, which may be reflective of enhanced supervision standards.
在当前的医疗保健环境下，人们越来越关注医疗错误、患者预后以及住院医师参与对这些指标的影响。其他研究已经研究了住院医师参与对手术结果的影响，但在增加了复杂性和学习曲线的显微外科领域，这一问题尚未得到调查。
对美国外科医师学会国家手术质量改进计划数据库进行回顾性分析，通过筛选现行手术术语代码寻找接受游离组织移植手术的患者。主要测量结果包括皮瓣失败、伤口、感染以及主要和次要并发症。
本研究在位于德克萨斯州休斯顿的卫理公会医院进行，该医院是一家学术医院。
本分析纳入了 2005 年至 2012 年间在国家手术质量改进计划数据库中接受显微外科手术的患者。
共有 1466 名患者符合纳入标准。主要并发症与年龄、周围血管疾病、美国麻醉医师协会（ASA）分级 3 或以上、总手术时间和手术年份显著相关。对次要并发症的多变量分析显示，ASA 分级 3 或 4 与显著相关。住院医师参与在任何结果测量中都不是一个重要因素，包括主要并发症、次要并发症、皮瓣失败、伤口并发症、感染并发症、需要输血的出血以及 30 天内意外再次手术率。
本研究进一步证明了住院医师参与显微外科手术是安全有效的，主要并发症、次要并发症、皮瓣失败和意外再次手术的发生率相似。ASA 分级高和周围血管疾病史是主要并发症的强烈预测因素，应在游离组织移植前进行术前优化。较晚的年份与主要并发症发生率降低相关，这可能反映了强化监督标准。
