From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
J Am Acad Orthop Surg. 2020 May 1;28(9):e401-e407. doi: 10.5435/JAAOS-D-18-00645.
The effect of spine fellow versus orthopaedic surgery resident assistance on outcomes in anterior cervical diskectomy and fusion (ACDF) has not been well studied. The objective of this study was to determine differences in patient health-related outcomes based on the level of surgical trainees.
Consecutive cases of ACDF (n = 407) were reviewed at a single high-volume institution between 2015 and 2017 and were separated into two groups based on whether they were fellow-assisted or resident-assisted. Demographic and clinical variables were recorded, and health-related quality of life was evaluated using the Short Form-12 (SF-12) survey. The SF-12, visual analog scale pain score, and neck disability index were compared between the two groups. Surgery level, surgical time, preoperative Charlson Comorbidity Index, estimated blood loss, equivalent morphine use, perioperative complications, and 30-day readmission were also recorded. Patient outcomes were compared using an unpaired t-test as well as multivariate linear regression, controlling for age, sex, body mass index, Charlson Comorbidity Index, presurgical visual analog scale, SF-12, and neck disability index. Results were reported with the 95% confidence interval.
Spine surgery fellows and orthopaedic surgery residents participated in 228 and 179 ACDF cases, respectively. No notable demographic differences between the two groups were found. A higher proportion of three or more level ACDF surgeries assisted by fellows versus residents was found. Estimated blood loss was greater in fellow-assisted ACDF cases. Both surgery time and total time in the room were also longer in the fellow-assisted ACDF group. No 30-day readmissions were found in either groups, and only one case of acute hemorrhagic anemia was found in the fellow-assisted group. Overall, postoperative complications were higher in the resident group; however, no difference with regard to intraoperative complications between groups was found.
This study shows that patient health-related outcomes are similar in ACDF cases that were fellow-assisted versus resident-assisted. However, fellow-assisted ACDF cases were associated with more blood loss and longer surgery time.
脊柱研究员与骨科住院医师协助对颈椎前路椎间盘切除术和融合术（ACDF）结果的影响尚未得到很好的研究。本研究的目的是根据手术受训者的水平确定患者健康相关结果的差异。
在一家高容量的机构中，对 2015 年至 2017 年间连续进行的 ACDF（n=407）病例进行回顾性研究，并根据是否接受研究员协助将其分为两组。记录人口统计学和临床变量，并使用简短形式-12（SF-12）调查评估健康相关生活质量。比较两组之间的 SF-12、视觉模拟疼痛评分和颈部残疾指数。还记录了手术水平、手术时间、术前 Charlson 合并症指数、估计失血量、等效吗啡使用量、围手术期并发症和 30 天再入院情况。使用未配对 t 检验和多元线性回归比较患者结局，同时控制年龄、性别、体重指数、Charlson 合并症指数、术前视觉模拟评分、SF-12 和颈部残疾指数。结果以 95%置信区间报告。
脊柱研究员和骨科住院医师分别参与了 228 例和 179 例 ACDF 手术。两组之间未发现明显的人口统计学差异。发现由研究员协助的三或更多水平 ACDF 手术比例较高。研究员协助的 ACDF 病例中估计失血量更大。研究员协助的 ACDF 组的手术时间和总手术时间也更长。两组均未发现 30 天再入院，研究员协助组仅发现一例急性出血性贫血。总体而言，住院医师组术后并发症较高；然而，两组之间未发现术中并发症的差异。
本研究表明，研究员协助与住院医师协助的 ACDF 病例患者健康相关结果相似。然而，研究员协助的 ACDF 病例与更多失血量和更长手术时间相关。
