Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center.
Circ J. 2020 Feb 25;84(3):495-500. doi: 10.1253/circj.CJ-19-0800. Epub 2020 Feb 5.
The aim of this study was to assess the impact of surgeon years of experience on clinical outcomes of tetralogy of Fallot (TOF) repair using technical performance score (TPS), and to investigate the possibility of safe operations by surgical trainees.
We assessed the cases of 159 consecutive patients who underwent TOF repair between 2001 and 2015. Thirteen different primary surgeons performed operations with 41 different first assistants. The primary surgeon and first assistant mean postgraduate years were 19.1±5.1 years (range, 5.7-31.6 years) and 11.2±6.3 years (range, 3.2-36.3 years), respectively. TPS was assigned using pre-discharge echocardiography based on original criteria. Logistic regression analysis was used to examine the factors associated with TPS. TPS could be scored for all patients, 16 of whom were graded as having optimal (10%), 119 as adequate (75%), and 24 as having inadequate (15%) TPS. None of the preoperative and perioperative variables affected TPS. Although neither the primary surgeon nor the first assistant postgraduate years was associated with TPS independently, total primary surgeon and first assistant postgraduate years correlated with TPS (OR, 1.07; 95% CI: 1.01-1.13, P=0.031).
Primary surgeon postgraduate years was not associated with TPS for TOF repair. TOF repair can be performed adequately and safely by surgical trainees under the support of highly experienced supervisors.
本研究旨在通过技术绩效评分（TPS）评估外科医生经验年限对法洛四联症（TOF）修复的临床结果的影响，并探讨由外科受训者进行安全手术的可能性。
我们评估了 2001 年至 2015 年间连续 159 例接受 TOF 修复的患者。13 名不同的主刀医生由 41 名不同的第一助手进行手术。主刀医生和第一助手的平均研究生学历分别为 19.1±5.1 年（范围 5.7-31.6 年）和 11.2±6.3 年（范围 3.2-36.3 年）。TPS 根据原始标准通过出院前超声心动图进行评分。使用逻辑回归分析来检查与 TPS 相关的因素。可以对所有患者进行 TPS 评分，其中 16 名患者被评为 TPS 为最佳（10%），119 名患者为 TPS 为充分（75%），24 名患者为 TPS 为不足（15%）。术前和围手术期的变量均未影响 TPS。尽管主刀医生和第一助手的研究生学历均未独立与 TPS 相关，但主刀医生和第一助手的总研究生学历与 TPS 相关（OR，1.07；95%CI：1.01-1.13，P=0.031）。
主刀医生的研究生学历与 TOF 修复的 TPS 无关。在经验丰富的主管医生的支持下，外科受训者可以进行充分和安全的 TOF 修复。
