Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
Surg Endosc. 2021 Jul;35(7):3387-3397. doi: 10.1007/s00464-020-07780-5. Epub 2020 Jul 8.
Resident operative involvement is an integral aspect of general surgery residency training. However, current data examining the effect of resident autonomy on perioperative outcomes remain limited.
Patient and operator-specific data were collected from 344 adult laparoscopic cholecystectomies at a tertiary academic institution and its regional affiliates between 2018 and 2019. Multivariate modeling compared postoperative outcomes between cases completed with or without resident involvement and its effect modification by resident seniority and autonomy per Zwisch scale. Outcomes include 30-day postoperative complications, hospital readmission rate, and operative time.
Multivariate analysis revealed resident involvement in laparoscopic cholecystectomy did not significantly change odds of 30-day postoperative complications (OR 2.52, p = 0.185, 95% CI 0.64-9.92) or hospital readmission (OR 1.61, p = 0.538, 95% CI 0.36-7.23). Operative time is significantly increased compared to faculty-only cases (IRR 1.37, p < 0.001, 95% CI 1.26-1.48). While accounting for case difficulty and resident performance evaluated by SIMPL criteria, stratification by resident autonomy measured by Zwisch scale or seniority reveal no effect modification on 30-day postoperative complications, readmissions, or operative time. The effect of resident involvement on longer relative rates of operative time loses its significance in supervision-only cases (IRR 1.18, p = 0.069, 95% CI 0.99-1.41).
While resident involvement and autonomy are associated with significantly longer operative times in laparoscopic cholecystectomy, their lack of significant effect on postoperative outcomes argues strongly for continued resident involvement and supervised operative independence.
住院医师的手术参与是普通外科住院医师培训的一个重要组成部分。然而，目前检查住院医师自主权对围手术期结果影响的数据仍然有限。
从 2018 年至 2019 年，在一家三级学术机构及其区域分支机构，对 344 例成人腹腔镜胆囊切除术的患者和手术医师的具体数据进行了收集。多变量模型比较了有或没有住院医师参与的病例之间的术后结果，以及住院医师资历和按 Zwisch 量表划分的自主权的影响修饰。结果包括 30 天术后并发症、医院再入院率和手术时间。
多变量分析显示，腹腔镜胆囊切除术住院医师参与并不会显著改变 30 天术后并发症的几率（OR 2.52，p=0.185，95%CI 0.64-9.92）或医院再入院率（OR 1.61，p=0.538，95%CI 0.36-7.23）。与仅由教员完成的病例相比，手术时间明显增加（IRR 1.37，p<0.001，95%CI 1.26-1.48）。尽管考虑了病例难度和 SIMPL 标准评估的住院医师表现，但按 Zwisch 量表或资历分层的住院医师自主权并没有对 30 天术后并发症、再入院率或手术时间产生影响修饰。住院医师参与对手术时间相对较长的影响在仅监督的病例中失去了意义（IRR 1.18，p=0.069，95%CI 0.99-1.41）。
尽管住院医师的参与和自主权与腹腔镜胆囊切除术中明显较长的手术时间相关，但它们对术后结果没有显著影响，这强烈支持继续让住院医师参与并进行监督下的手术独立性。
