Leong Joon Yau, Calio Brian, Shah Mihir, Sullivan Patrick, Trabulsi Edouard J, Gomella Leonard G, Lallas Costas D
Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Can J Urol. 2019 Apr;26(2):9694-9698.
An important aspect of overlapping surgery is to determine the 'critical portion' of an operation. Currently, there are no guidelines that standardize the critical portions of common urologic procedures. We sought to determine the relationship between the critical portions of common urologic operations as defined by the primary surgeon compared to the trainee at a single academic medical center.
In an open-ended survey of the Urology Department at Thomas Jefferson University, attending surgeons and urology residents, were asked to list five of their most commonly performed surgeries and subsequently identify what they defined as the critical portion for each. Responses were examined for surgeon-trainee congruence. Response agreement was defined as identifying key words that provided reasonable evidence that the responders were referring to identical portions of the case.
Nine residents and eight attending physicians provided 67 and 63 responses, respectively, encompassing 28 different procedures. Six procedures were chosen for further analysis based on high volume of responses. Overall, of the 67 resident-reported critical portions, 32 (47.8%) were in agreement with attending-reported critical portions. Year of training in residency was not a predictor of surgeon-trainee agreement.
External pressures from the public and lawmakers alike may demand that providers be present during all 'critical portions' of a procedure. Our study shows that the understanding of critical portions of an operation is often incongruent between surgeons and trainees. Critical portions of all procedures should be established by the surgical team in order to accurately schedule overlapping surgeries.
重叠手术的一个重要方面是确定手术的“关键部分”。目前，尚无规范常见泌尿外科手术关键部分的指南。我们试图确定在单一学术医疗中心，主刀医生与实习医生所定义的常见泌尿外科手术关键部分之间的关系。
在对托马斯·杰斐逊大学泌尿外科进行的一项开放式调查中，要求主治外科医生和泌尿外科住院医师列出他们最常进行的五项手术，随后确定他们认为每项手术的关键部分是什么。检查回答以确定医生与实习医生的一致性。回答的一致性定义为识别出能提供合理证据表明回答者所指的是病例相同部分的关键词。
九名住院医师和八名主治医生分别给出了67份和63份回答，涵盖28种不同手术。基于大量的回答，选择了六种手术进行进一步分析。总体而言，在住院医师报告的67个关键部分中，32个（47.8%）与主治医生报告的关键部分一致。住院医师培训年份并非医生与实习医生一致性的预测因素。
来自公众和立法者等方面的外部压力可能要求在手术的所有“关键部分”都有医护人员在场。我们的研究表明，外科医生和实习医生对手术关键部分的理解往往不一致。手术团队应确定所有手术的关键部分，以便准确安排重叠手术。
