Bougie Olga, Zuckerman Scott L, Switzer Noah, How Jeffrey, Sey Michael
Harvard T.H. Chan School of Public Health, Boston, MA; Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON.
Harvard T.H. Chan School of Public Health, Boston, MA; Vanderbilt University Medical Center, Nashville, TN.
J Obstet Gynaecol Can. 2018 Sep;40(9):1170-1177. doi: 10.1016/j.jogc.2017.10.035. Epub 2018 Jul 11.
The effect of resident involvement during obstetrics and gynaecology (OB/GYN) surgery on surgical outcomes is unclear. This study sought to review the evidence systematically for the influence of resident participation in OB/GYN surgery on (1) operative time, (2) estimated blood loss, and (3) perioperative complications.
Published studies were identified via searches of PubMed, Embase, Cochrane Central Register, Web of Science, and ClinicalTrials.gov databases. The study included randomized or observational studies that compared outcomes for OB/GYN surgery performed by attending surgeons alone or with residents. Risk ratios or mean differences were extracted from the studies. A random effect model was performed for each outcome, with subgroup analysis by type of surgery and study quality.
A total of 13 studies were included in the meta-analysis, comprising 40 968 patients in seven countries. Surgical procedures performed only by attending surgeons had shorter operative times (mean difference 18.20 minutes; 95% CI 13.58-22.82), whereas surgical procedures with resident involvement were associated with an increased risk of blood transfusion (risk ratio 1.23; 95% CI 1.08-1.41). There were no observable differences in risk of estimated blood loss, wound infection, urologic injury, viscus injury, or return to the operating room. Significant heterogeneity (I >50%) was present in one of seven outcomes.
Resident participation in OB/GYN surgery is associated with longer operative times and increased risk of blood transfusion; however, other perioperative complications are not increased.
住院医师参与妇产科（OB/GYN）手术对手术结果的影响尚不清楚。本研究旨在系统回顾住院医师参与妇产科手术对以下方面影响的证据：（1）手术时间；（2）估计失血量；（3）围手术期并发症。
通过检索PubMed、Embase、Cochrane中央注册库、科学引文索引和ClinicalTrials.gov数据库来识别已发表的研究。该研究纳入了比较由主治医生单独进行或与住院医师共同进行的妇产科手术结果的随机或观察性研究。从这些研究中提取风险比或均值差异。对每个结果进行随机效应模型分析，并按手术类型和研究质量进行亚组分析。
荟萃分析共纳入13项研究，涉及7个国家的40968例患者。仅由主治医生进行的手术操作手术时间较短（均值差异18.20分钟；95%置信区间13.58 - 22.82），而有住院医师参与的手术操作输血风险增加（风险比1.23；95%置信区间1.08 - 1.41）。在估计失血量、伤口感染、泌尿系统损伤、脏器损伤或返回手术室的风险方面没有观察到差异。七个结果中的一个存在显著异质性（I² >50%）。
住院医师参与妇产科手术与手术时间延长和输血风险增加相关；然而，其他围手术期并发症并未增加。
