Hasan Obada, Amin Mashal, Rabbani Umar, Rabbani Amna, Mahmood Fatima, Noordin Shahryar
Orthopaedic & Rehabilitation Department, University of Iowa, United States.
Department of Pediatric Medicine, The Aga Khan University Hospital, Pakistan.
Ann Med Surg (Lond). 2020 Jun 18;56:116-120. doi: 10.1016/j.amsu.2020.06.017. eCollection 2020 Aug.
Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients' morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the "new residents' induction effect" on postoperative complications after hip fracture surgeries.
This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care and level 1 trauma centre of a metropolitan city between 2008 and 2018. We defined primary exposure as the time period of new resident's induction (January-March) with the primary outcome in-hospital and 30days postoperative complications. Cox proportional hazard algorithm analysis was done at univariate and multivariable levels reporting Crude Relative Risk (RR) and Adjusted Relative Risk (aRR), respectively. Results were reported in line with STROBE criteria.
There were 274 (26%) patients in exposed group out of whom 109 (40%) developed postoperative complications. Interestingly, patients who had their surgeries during the induction period of new residents had 8% less risk of developing postoperative complications. However, result was statistically insignificant at both univariate and multivariable levels with RR; 95% C.I of 0.9 (0.78-1.22) and aRR; 95% C.I of 0.9 (0.78-1.22) after adjusting for the all other independent variables.
The association of new residents' induction on postoperative hip fracture surgery complications, although protective, was insignificant after controlling for the potential confounding effect of patients' background and demographic characteristics. We recommend further multi-centre high powered studies to analyze this.
大多数机构每年都会对新入职的住院医师和外科实习生进行培训。没有经验的新住院医师可能会对外科手术结果构成威胁，这种人员更替可能会导致患者发病率和死亡率潜在增加。关于这种影响，文献尚无定论。我们的目的是研究髋部骨折手术后“新住院医师培训效应”对术后并发症的影响。
这是一项来自大学医院的非资助、非商业化研究。研究人员对2008年至2018年期间在我们大都市的三级医疗和一级创伤中心接受手术的1045例成年髋部骨折患者进行了回顾性队列研究。我们将主要暴露定义为新住院医师培训期间（1月至3月），主要结局为住院期间及术后30天并发症。在单变量和多变量水平上进行Cox比例风险算法分析，分别报告粗相对风险（RR）和调整后相对风险（aRR）。结果按照STROBE标准报告。
暴露组有274例（26%）患者，其中109例（40%）发生术后并发症。有趣的是，在新住院医师培训期间接受手术的患者发生术后并发症的风险降低了8%。然而，在单变量和多变量水平上，RR的结果在统计学上均无显著性；在调整所有其他自变量后，95%置信区间为0.9（0.78 - 1.22），aRR的95%置信区间为0.9（0.78 - 1.22）。
尽管新住院医师培训与髋部骨折手术后并发症之间的关联具有保护作用，但在控制了患者背景和人口统计学特征的潜在混杂效应后，这种关联并不显著。我们建议进一步开展多中心、大样本研究对此进行分析。
