Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.
National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK.
Br J Surg. 2020 Sep;107(10):1289-1298. doi: 10.1002/bjs.11611. Epub 2020 Apr 26.
To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at emergency laparotomy. The aim of this study was to describe the patterns of trainee-led emergency laparotomy operating and the association between postoperative outcomes.
Data on all patients who had an emergency laparotomy between December 2013 and November 2017 were extracted from the National Emergency Laparotomy Audit database. Patients were grouped by grade of operating surgeon: trainee (specialty registrar) or consultant (including post-Certificate of Completion of Training fellows). Trends in trainee operating by deanery, hospital size and time of day of surgery were investigated. Univariable and adjusted regression analyses were performed for the outcomes 90-day mortality and return to theatre, with analysis of patients in operative subgroups segmental colectomy, Hartmann's procedure, adhesiolysis and repair of perforated peptic ulcer disease.
The study cohort included 87 367 patients. The 90-day mortality rate was 15·1 per cent in the consultant group compared with 11·0 per cent in the trainee group. There were no increased odds of death by 90 days or of return to theatre across any of the operative groups when the operation was performed with a trainee listed as the most senior surgeon in theatre. Trainees were more likely to operate independently in high-volume centres (highest- versus lowest-volume centres: odds ratio (OR) 2·11, 95 per cent c.i. 1·91 to 2·33) and at night (00.00 to 07.59 versus 08.00 to 11.59 hours; OR 3·20, 2·95 to 3·48).
There is significant variation in trainee-led operating in emergency laparotomy by geographical area, hospital size and by time of day. However, this does not appear to influence mortality or return to theatre.
为了完成普通外科的培训要求，受训者必须在急诊剖腹手术中展示常见手术的能力。本研究旨在描述受训者主导的急诊剖腹手术操作模式，以及手术操作模式与术后结果之间的关联。
从国家急诊剖腹手术审计数据库中提取了 2013 年 12 月至 2017 年 11 月期间所有接受急诊剖腹手术的患者的数据。根据手术医生的级别（专科住院医师或顾问医生，包括完成培训证书后的研究员）将患者分组。研究了不同区域、医院规模和手术时间由受训者主导手术的趋势。对 90 天死亡率和再次手术的结果进行单变量和调整后的回归分析，并对手术亚组（部分结肠切除术、Hartmann 手术、粘连松解术和穿孔性消化性溃疡病修复术）的患者进行分析。
本研究队列包括 87367 名患者。顾问组的 90 天死亡率为 15.1%，而受训者组为 11.0%。当手术时由受训者担任手术室中最高级别的外科医生时，在任何手术组中，90 天死亡率或再次手术的可能性均无增加。受训者更有可能在高容量中心独立手术（最高容量中心与最低容量中心相比：优势比（OR）2.11，95%置信区间（CI）1.91 至 2.33），并且在夜间（00.00 至 07.59 小时与 08.00 至 11.59 小时相比；OR 3.20，2.95 至 3.48）。
在急诊剖腹手术中，由受训者主导的手术操作存在显著的地域、医院规模和时间差异。然而，这似乎并不影响死亡率或再次手术的可能性。
