Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa.
J Bone Joint Surg Am. 2018 Nov 21;100(22):1919-1925. doi: 10.2106/JBJS.18.00279.
Few studies have evaluated the effect of resident participation on morbidity and mortality after orthopaedic trauma surgery. The goal of this study was to evaluate whether complications after orthopaedic trauma procedures involving residents correlate with the level of resident training and the timing in the academic year.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent operative fixation of proximal femoral fractures, femoral shaft fractures, and tibial shaft fractures from 2005 to 2012. A total of 1,851 cases with resident involvement were identified, and complication rates were calculated and analyzed with respect to resident level of training (postgraduate year [PGY] 1 through 6) and the academic quarter in which the procedure took place.
The composite complication rates in the first academic quarter for serious adverse events (10.96%), any adverse events (18.57%), and surgical complications (9.62%) did not significantly differ from those during the remainder of the year (11.40%, 17.81%, and 7.19%, respectively). The rates of any adverse event were significantly higher for senior-level residents (quarter 1, 20.58%; quarter 2, 20.05%) than for junior residents (quarter 1, 11.76%; quarter 2, 12.44%) during the first half of the academic year (quarter 1, p = 0.044; quarter 2, p = 0.024).
This evaluation of the composite complication rates found no "July effect" in lower-extremity orthopaedic trauma surgery. There was evidence for a July effect for superficial surgical site infections, in that there was a significantly higher rate in the first academic quarter. Senior residents may benefit from more oversight or instruction during the first portion of the academic year.
很少有研究评估住院医师参与对骨科创伤手术后发病率和死亡率的影响。本研究的目的是评估涉及住院医师的骨科创伤手术后并发症是否与住院医师培训水平和学年时间有关。
从 2005 年至 2012 年，美国外科医师学会国家手术质量改进计划数据库中检索所有接受股骨近端骨折、股骨干骨折和胫骨骨干骨折手术内固定的患者。共确定了 1851 例有住院医师参与的病例，并根据住院医师的培训水平（住院医师 1 年至 6 年）和手术发生的学术季度计算和分析并发症发生率。
在第一个学术季度，严重不良事件（10.96%）、任何不良事件（18.57%）和手术并发症（9.62%）的综合并发症发生率与当年剩余时间（分别为 11.40%、17.81%和 7.19%）无显著差异。在上半年，高级住院医师的任何不良事件发生率明显高于初级住院医师（第一季度，20.58%；第二季度，20.05%）（第一季度，p=0.044；第二季度，p=0.024）。
对综合并发症发生率的评估未发现下肢骨科创伤手术中存在“7 月效应”。浅表手术部位感染存在 7 月效应的证据，即第一个学术季度的发生率明显更高。高级住院医师可能需要在学年的前半部分接受更多的监督或指导。
