University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, U.S.A..
University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, Iowa, U.S.A.
Arthroscopy. 2020 Oct;36(10):2689-2695. doi: 10.1016/j.arthro.2020.04.040. Epub 2020 May 8.
To investigate whether resident involvement in knee arthroscopy procedures affects postoperative complications or operative times.
The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent common knee arthroscopy procedures between 2006 through 2012. Patients with a history of knee arthroplasty, septic arthritis or osteomyelitis of the knee, concomitant open or mini-open procedures, or without information on resident involvement were excluded. A 1:1 propensity score match was performed based on age, sex, obesity, smoking history, and American Society of Anesthesiologist classification to match cases with resident involved to nonresident cases. Fisher exact tests, Pearson's χ tests, and Wilcoxon rank sum tests were used to compare patient demographics, comorbidities, and 30-day complications. Wilcoxon rank sum tests were used to compare operative time and length of hospital stay between the 2 groups, with statistical significance defined as P < .05.
After matching, 2954 cases (50% resident involvement) were included in the study with no significant differences in demographics or comorbidities between the 2 cohorts. The overall rate of 30-day complications was 1.1% in the nonresident and resident involved group (P = 1.000). There was no significant difference in postoperative surgical (nonresident vs resident involved: 0.48% vs 0.83%, P = .2498) or medical (nonresident vs resident involved: 0.62% vs 0.83%, P = .5111) complications. However, knee arthroscopy cases that residents were involved with had significantly longer operative times (69.8 vs 66.8 minutes, P = .0002), and length of hospital stay (0.85 vs 0.21 days, P = .0332) when compared with cases performed without a resident.
Resident involvement in knee arthroscopy procedures is not a significant risk for medical or surgical 30-day postoperative complications. Resident participation in knee arthroscopy was associated with statistically significant but likely clinically insignificant increased operative time as well as length of hospital stay.
Level III: Retrospective Cohort Study.
探讨住院医师参与膝关节镜手术是否会影响术后并发症或手术时间。
查询美国外科医师学会国家手术质量改进计划登记处，以确定 2006 年至 2012 年间接受常见膝关节镜手术的患者。排除有膝关节置换术、化脓性关节炎或骨髓炎病史、同时进行开放或小切口手术、或无住院医师参与信息的患者。根据年龄、性别、肥胖、吸烟史和美国麻醉医师协会分类，对病例进行 1:1 倾向评分匹配，以匹配有住院医师参与的病例和无住院医师参与的病例。采用 Fisher 确切检验、Pearson χ检验和 Wilcoxon 秩和检验比较患者的人口统计学、合并症和 30 天并发症。Wilcoxon 秩和检验用于比较两组之间的手术时间和住院时间，统计学意义定义为 P<.05。
匹配后，研究纳入 2954 例（50%住院医师参与），两组患者在人口统计学和合并症方面无显著差异。非住院医师组和住院医师组的 30 天并发症总发生率为 1.1%（P=1.000）。术后手术（非住院医师 vs 住院医师：0.48% vs 0.83%，P=.2498）和医疗（非住院医师 vs 住院医师：0.62% vs 0.83%，P=.5111）并发症无显著差异。然而，与没有住院医师参与的病例相比，住院医师参与的膝关节镜手术操作时间明显更长（69.8 分钟 vs 66.8 分钟，P=.0002），住院时间也更长（0.85 天 vs 0.21 天，P=.0332）。
住院医师参与膝关节镜手术并不增加医疗或手术 30 天术后并发症的风险。住院医师参与膝关节镜手术与手术时间显著增加但可能临床意义不大以及住院时间延长相关。
III 级，回顾性队列研究。
