Caveney Maxx, Matthews Catherine, Mirzazadeh Majid
From the *Wake Forest School of Medicine; and †Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC.
Female Pelvic Med Reconstr Surg. 2017 Nov/Dec;23(6):387-391. doi: 10.1097/SPV.0000000000000436.
The primary aim of this study was to assess the effect of resident involvement on perioperative complication rates in pelvic organ prolapse surgery using the National Surgical Quality Improvement database.
All pelvic organ prolapse operations from 2006 to 2012 were identified and dichotomized by resident participation. Preoperative characteristics and 30-day perioperative outcomes were compared using χ and Student t test. To control for nonrandomization of cases, propensity scores representing the probability of resident involvement as a function of a case's comorbidities were calculated. They were then divided into quartiles, and because of equal probabilities for the first and second quartiles, 3 groups were created (Q1/2, Q3, and Q4), followed by substratification and analysis. As a control, complications of transurethral resection of prostate and nephrectomy were dichotomized by resident involvement.
We identified 2637 cases. Resident involvement was associated with increased postoperative urinary tract infections, perioperative complications, and procedure length. After stratification by propensity scoring, the following unique findings occurred in each group: in the first group, resident involvement was associated with increased rates of readmission, pulmonary embolism, and sepsis; in the second and third groups, resident involvement was associated with increased rates of superficial surgical site infection. Resident involvement in nephrectomy observed increased perioperative complications and procedural length. In prostate resection, increased procedure lengths and decreased postoperative length of stay were observed.
Resident involvement in pelvic organ prolapse surgery was associated with an increased risk of adverse outcomes. A similar effect was seen with nephrectomy but not with a more simple endoscopic urologic procedure.
本研究的主要目的是利用国家外科质量改进数据库评估住院医师参与对盆腔器官脱垂手术围手术期并发症发生率的影响。
确定2006年至2012年所有盆腔器官脱垂手术，并根据住院医师参与情况进行二分法分类。使用χ检验和学生t检验比较术前特征和30天围手术期结果。为控制病例的非随机化，计算代表住院医师参与概率与病例合并症函数关系的倾向评分。然后将其分为四分位数，由于第一和第二四分位数概率相等，创建了3组（Q1/2、Q3和Q4），随后进行亚分层和分析。作为对照，经尿道前列腺切除术和肾切除术的并发症根据住院医师参与情况进行二分法分类。
我们确定了2637例病例。住院医师参与与术后尿路感染、围手术期并发症增加以及手术时间延长有关。按倾向评分分层后，每组出现以下独特发现：在第一组中，住院医师参与与再入院率、肺栓塞和脓毒症增加有关；在第二和第三组中，住院医师参与与浅表手术部位感染率增加有关。住院医师参与肾切除术观察到围手术期并发症增加和手术时间延长。在前列腺切除术中，观察到手术时间延长和术后住院时间缩短。
住院医师参与盆腔器官脱垂手术与不良结局风险增加有关。肾切除术也观察到类似效果，但更简单的内镜泌尿外科手术则未观察到。
