Department of Surgery, Advocate Illinois Masonic Medical Center, University of Illinois at Chicago/Metropolitan Group Hospitals, 836 W. Wellingtom Ave, Chicago, IL, 60657, USA.
Department of Surgery, Mercy Hospital and Medical Center, Chicago, USA.
Surg Endosc. 2021 Aug;35(8):4581-4584. doi: 10.1007/s00464-020-07879-9. Epub 2020 Aug 17.
Outcome studies have failed to show significant improvement related to formal fellowship training in different surgical specialties. We aimed to look whether laparoscopic fellowship-trained (FT) surgeons had better outcomes.
This is an IRB approved retrospective review from a single institution (inner city hospital) on adults undergoing appendectomy from 2008 to 2017. Demographics and 30-day complications were analyzed with univariate and multivariate logistic regression analyses.
Total of 558 appendectomies were reviewed. 151 (27.36%) appendectomies were performed by FT surgeons (MIS/CRS), 401 (72.64%) performed by GS. No difference in age, ASA, BMI, race, gender, insurance status, smoking, diabetes mellitus (DM), or hypertension was found. Also, similar rates of non-iatrogenic perforated appendicitis were seen (16.37% GS vs 20% FT, p = 0.318). For major complications, no difference was found between GS and FT (p = 0.63). However, appendectomies performed by GS showed higher rates of post-op ileus (3.99% vs 0.66%, p = 0.04), higher conversion to open (7.55% vs 2.67%, p = 0.039), higher rates of choosing an open approach (17.46% vs 0.66%, p = < 0.001), and longer length of stay (LOS) (median 1.9 vs 1.8 days p = 0.048). Of the 16 patients with ileus from the GS group three were open, two converted to open, and eleven laparoscopic with mean OR time of 70 min and LOS of 13.3 days. The only laparoscopic case from the FT group with ileus had a mean operative time of 56 min and LOS of 15 days. On multivariate regression analysis, only DM was found as risk factor for major complications (OR 3.01, 95% CI 1.307-6.92, p = 0.01), while laparoscopic approach was seen as protective factor against major complications (OR 0.53, 95% CI 0.29-0.97, p = 0.04).
Laparoscopic fellowship training had a positive outcome on post-op ileus and LOS after appendectomy. This seems to be related to the higher prevalence of choosing laparoscopic technique and lower rate of conversion to open.
不同外科专业的规范化专科医师培训并没有显示出明显的相关效果。我们旨在研究腹腔镜专科医师培训（FT）是否会带来更好的结果。
这是一项经机构审查委员会批准的回顾性研究，来自一家单机构（城市内医院），纳入 2008 年至 2017 年期间接受阑尾切除术的成年人。通过单变量和多变量逻辑回归分析，评估患者的人口统计学资料和 30 天内的并发症。
共回顾了 558 例阑尾切除术。151 例（27.36%）由 FT 医师（微创/经肛门内镜手术）完成，401 例（72.64%）由 GS 医师完成。两组在年龄、ASA 分级、BMI、种族、性别、保险状况、吸烟、糖尿病（DM）或高血压方面无差异。非医源性穿孔性阑尾炎的发生率也相似（GS 组 16.37%，FT 组 20%，p=0.318）。在主要并发症方面，GS 组和 FT 组之间无差异（p=0.63）。然而，GS 组的术后肠麻痹发生率更高（3.99% vs 0.66%，p=0.04），中转开腹率更高（7.55% vs 2.67%，p=0.039），选择开腹手术的比例更高（17.46% vs 0.66%，p= < 0.001），住院时间（LOS）更长（中位数 1.9 天 vs 1.8 天，p=0.048）。GS 组的 16 例肠麻痹患者中，有 3 例开腹，2 例中转开腹，11 例行腹腔镜手术，平均手术时间为 70 分钟，LOS 为 13.3 天。FT 组唯一 1 例肠麻痹患者腹腔镜手术平均手术时间为 56 分钟，LOS 为 15 天。多变量回归分析显示，只有 DM 是主要并发症的危险因素（OR 3.01，95%CI 1.307-6.92，p=0.01），而腹腔镜手术是预防主要并发症的保护因素（OR 0.53，95%CI 0.29-0.97，p=0.04）。
腹腔镜专科医师培训对阑尾切除术后肠麻痹和 LOS 有积极影响。这似乎与选择腹腔镜技术的比例较高和中转开腹的比例较低有关。
