Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY, USA.
J Neurooncol. 2017 Dec;135(3):613-619. doi: 10.1007/s11060-017-2614-6. Epub 2017 Aug 30.
Prior studies exploring the impact of resident involvement on complication and mortality rates in neurosurgery have evaluated heterogeneous cohorts. Since brain tumor resection is characterized by significant operative complexity, variety, and morbidity, intraoperative resident involvement has the potential to impact patient outcomes. The purpose of this study was thus to explore the relationship between resident involvement and patient outcomes following craniotomy for brain tumor resection. Data for adult patients undergoing craniotomy for brain tumor resection were extracted from the 2008-2014 National Surgical Quality Improvement Program database. Resident involvement was determined for all included cases, and evaluated for association with patient outcomes via multivariable, binary logistic regression modeling while controlling for perioperative variables. Outcomes included death, prolonged length of stay (LOS), readmission, reoperation, and pertinent complications. A total of 3587 cases met the inclusion criteria, 2926 (81.6%) of which were supratentorial tumors and 661 (18.4%) were infratentorial lesions. Residents were involved in 63.6% of cases. Resident participation was associated with a reduced incidence of prolonged LOS (OR 0.68, 95% CI 0.54-0.86, P = 0.001) and urinary tract infection (UTI) (OR 0.63, 95% CI 0.40-0.98, P = 0.038), and approached significance for reduced mortality rate (OR 0.63, 95% CI 0.39-1.03, P = 0.064). These associations were observed for patients with supratentorial tumors but not for those with infratentorial lesions. Resident involvement was not significantly associated with any of the other outcome metrics. Resident involvement was not a risk factor for any adverse events, and was associated with reduced incidence of prolonged LOS and UTI. The observed relationships may be impacted by institution-level factors.
先前探索住院医师参与对神经外科并发症和死亡率影响的研究评估了异质队列。由于脑肿瘤切除术具有显著的手术复杂性、多样性和发病率，住院医师的术中参与有可能影响患者的结局。因此，本研究旨在探讨脑肿瘤切除术开颅术后住院医师参与与患者结局之间的关系。从 2008-2014 年国家手术质量改进计划数据库中提取接受脑肿瘤切除术开颅术的成年患者数据。对所有纳入病例确定住院医师的参与情况，并通过多变量二项逻辑回归模型进行评估，同时控制围手术期变量与患者结局的关系。结果包括死亡、住院时间延长（LOS）、再入院、再次手术和相关并发症。共有 3587 例符合纳入标准，其中 2926 例（81.6%）为幕上肿瘤，661 例（18.4%）为幕下病变。63.6%的病例中住院医师参与。住院医师的参与与 LOS 延长发生率降低相关（OR 0.68，95%CI 0.54-0.86，P=0.001）和尿路感染（UTI）（OR 0.63，95%CI 0.40-0.98，P=0.038），并且与死亡率降低（OR 0.63，95%CI 0.39-1.03，P=0.064）接近显著相关。这些关联仅在幕上肿瘤患者中观察到，而在幕下病变患者中则没有观察到。住院医师的参与与任何其他结果指标均无显著相关性。住院医师的参与不是任何不良事件的危险因素，与 LOS 延长和 UTI 发生率降低相关。观察到的关系可能受到机构层面因素的影响。
