Department of Surgery, Section of Pediatric Surgery at Yale School of Medicine, New Haven, Connecticut.
Department of Surgery, Section of Pediatric Surgery at Yale School of Medicine, New Haven, Connecticut.
J Surg Educ. 2019 Jul-Aug;76(4):1005-1014. doi: 10.1016/j.jsurg.2019.02.007. Epub 2019 Mar 20.
Previous studies reveal a correlation between surgical volume and outcomes; thus, a similar relationship likely exists between trainee operative volume and technical competence. While routine hepatobiliary surgery is commonplace, trainee exposure to the more advanced procedures may be lacking. We hypothesize that experience in complex hepatobiliary procedures may be deficient both during general surgery residency and pediatric surgery fellowship training.
Case log data from the ACGME were queried for general surgery residents (2000-2017) and pediatric surgery fellows (2004-2017). Laparoscopic cholecystectomy was considered a routine hepatobiliary procedure for both specialties. For general surgery, hepatic lobectomy/segmentectomy and choledochoenteric anastomosis were considered complex and for pediatric surgery, hepatic lobectomy, biliary atresia and choledochal cyst procedures were considered complex.
Publicly available case log data from the ACGME.
General surgery residents and pediatric surgery fellows at ACGME-accredited training programs.
The number of trainees increased over the study period for both groups. Mean case volumes for laparoscopic cholecystectomy increased by 36% in surgery graduates and by 114% in pediatric surgery graduates. In surgery, the mean volumes for choledochoenteric anastomosis procedures decreased by 53% from 3.0 to 1.4 procedures/year with increasing variability in trainee experience. Volumes for hepatic lobectomy/segmentectomy increased by 68% from 3.4 to 5.7 procedures/year with decreasing variability. In pediatric surgery, case volumes for complex procedures were low (mean <4/year), highly variable among trainees, and appear unchanged between 2004 and 2017. In every year analyzed, at least 1 pediatric surgery trainee reported doing 0 cases in one of these complex categories.
Case logs suggest that the volume of complex hepatobiliary surgery remains low and highly variable in both disciplines with some trainees obtaining minimal or no exposure to certain cases. The relationship between these trends and the development of competency is worthy of further study.
先前的研究表明手术量与结果之间存在相关性；因此，受训者的手术量与技术能力之间可能也存在类似的关系。虽然常规肝胆手术很常见，但受训者可能缺乏更先进的手术经验。我们假设，在普通外科住院医师培训和小儿外科研究员培训期间，复杂肝胆手术的经验可能不足。
从 ACGME 的病例记录数据中查询普通外科住院医师（2000-2017 年）和小儿外科研究员（2004-2017 年）的信息。腹腔镜胆囊切除术被认为是这两个专业的常规肝胆手术。对于普通外科，肝叶切除术/肝段切除术和胆肠吻合术被认为是复杂手术，而对于小儿外科，肝叶切除术、胆道闭锁和胆总管囊肿手术被认为是复杂手术。
ACGME 提供的公开病例记录数据。
ACGME 认可的培训计划中的普通外科住院医师和小儿外科研究员。
在研究期间，两组受训者的数量都有所增加。腹腔镜胆囊切除术的平均手术量在外科毕业生中增加了 36%，在小儿外科毕业生中增加了 114%。在外科，胆肠吻合术的平均手术量从 3.0 例/年减少到 1.4 例/年，而受训者经验的变化则减少了 53%。肝叶切除术/肝段切除术的手术量从 3.4 例/年增加到 5.7 例/年，变化幅度减小。在小儿外科中，复杂手术的病例量较低（平均<4 例/年），在受训者之间差异很大，并且在 2004 年至 2017 年之间似乎没有变化。在每年的分析中，至少有 1 名小儿外科受训者报告在这些复杂类别中的某个类别中完成了 0 例手术。
病例记录表明，这两个学科的复杂肝胆手术量仍然较低，且差异很大，某些受训者的手术经验很少或没有。这些趋势与能力发展之间的关系值得进一步研究。
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