第一助手训练水平对青少年特发性脊柱侧凸手术结果的影响。

The Effect of the Level of Training of the First Assistant on the Outcomes of Adolescent Idiopathic Scoliosis Surgery.

机构信息

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania.

出版信息

J Bone Joint Surg Am. 2019 Mar 20;101(6):e23. doi: 10.2106/JBJS.18.00018.

DOI:10.2106/JBJS.18.00018

PMID:30893240

Abstract

BACKGROUND

At academic medical centers, residents and fellows play an integral role as surgical first assistants in spinal deformity surgery. However, limited data exist on whether the experience level of the surgical assistant affects outcomes.

METHODS

We conducted a multicenter, multisurgeon study comparing perioperative and postoperative outcomes after adolescent idiopathic scoliosis (AIS) surgery for the same 11 surgeons who performed cases that were assisted by residents compared with cases that were assisted by fellows. Blood loss, operative time, duration of hospitalization, complication rates, Scoliosis Research Society (SRS)-22 questionnaire scores, and radiographic outcomes were compared between the 2 groups.

RESULTS

We evaluated outcomes for 347 surgical procedures; 118 cases were assisted by residents and 229 were assisted by fellows. Preoperative radiographic and demographic parameters were not different between the groups. The resident group had significantly more estimated blood loss than the fellow group (939 compared with 762 mL, p = 0.02). Otherwise, the perioperative characteristics were similar between the groups, including the volume of the autologous blood recovery system product that was transfused, the operative time, and the occurrence of intraoperative neuromonitoring changes. Postoperatively, the percentage correction of the Cobb angle, the number of levels that had been fused, the number of days until the discharge criteria had been met, and the rate of major complications were similar between the groups. At the 2-year follow-up, the overall and subdomain SRS-22 questionnaire scores were not different between the groups, except that patients in the resident-assisted group had slightly worse pain scores than those in the fellow-assisted group (4.3 compared with 4.5, p = 0.01).

CONCLUSIONS

The first assistant's level of training did not affect clinical or radiographic outcomes following AIS surgery.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

在学术医学中心，住院医师和研究员在脊柱畸形手术中作为外科第一助手发挥着不可或缺的作用。然而，关于手术助手的经验水平是否会影响结果的数据有限。

方法

我们进行了一项多中心、多外科医生的研究，比较了在同一位外科医生进行的青少年特发性脊柱侧凸（AIS）手术中，由住院医师和研究员协助的病例的围手术期和术后结果。比较了两组之间的失血量、手术时间、住院时间、并发症发生率、脊柱侧凸研究协会（SRS）-22 问卷评分和影像学结果。

结果

我们评估了 347 例手术的结果；其中 118 例由住院医师协助，229 例由研究员协助。两组患者术前影像学和人口统计学参数无差异。住院医师组的估计失血量明显多于研究员组（939 比 762 毫升，p = 0.02）。除此之外，两组的围手术期特征相似，包括自体血回收系统产品的输血量、手术时间和术中神经监测变化的发生。术后，Cobb 角的矫正百分比、融合的节段数、达到出院标准的天数以及主要并发症的发生率在两组之间相似。在 2 年的随访中，两组的总体和亚领域 SRS-22 问卷评分无差异，但住院医师组的患者疼痛评分略低于研究员组（4.3 比 4.5，p = 0.01）。