Division of Cancer Sciences, School of Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
Obstetrics and Gynaecology, Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
Int J Gynecol Cancer. 2020 Dec;30(12):1959-1965. doi: 10.1136/ijgc-2020-001834. Epub 2020 Oct 12.
Older patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.
A web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1-7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.
Of the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.
Obstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.
接受癌症手术的老年患者术后并发症、住院时间延长和死亡率的风险增加。虚弱的识别可以帮助预测围手术期并发症高危患者，并允许协作的多学科团队对其进行治疗。进行了一项调查，以评估妇产科住院医师对虚弱妇科肿瘤患者围手术期问题的识别和处理的信心和知识。
通过 Audit and Research in Gynaecological Oncology (ARGO) 协作组织和 UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) 在网上发布了一份关于虚弱围手术期患者管理的调查。该调查分发给在英国（英国）和爱尔兰从事妇产科工作的住院医师（受训者）。符合条件的是专科（ST1-7）、亚专科和普通实践住院医师、非培训级医生和目前在妇产科工作的基础年医生。不包括顾问。研究数据使用 REDCAP 软件在曼彻斯特大学收集。在 2020 年 1 月至 2 月的 6 周期间收集了答复。
在 666 名参加的住院医师中，67%（425/666）报告围手术期管理虚弱患者的培训不足。只有 9%（59/638）的受训者使用了经过验证的虚弱评估工具，不到 1%（4/613）的受训者能够正确识别所有虚弱的诊断特征。常见的误解包括在虚弱评估中使用年龄和性别。大多数住院医师（76.5%，448/586）正确回答了一系列与精神能力有关的问题；然而，只有 6%（36/606）能够正确识别谵妄的所有三个诊断特征。共有 87%（495/571）的住院医师支持与老年病学家更密切的合作和多学科方法。
妇产科住院医师报告说，在虚弱妇科肿瘤患者的围手术期护理方面培训不足，绝大多数人赞成老年病学家的意见。常规使用经过验证的虚弱评估工具可能有助于在围手术期环境中诊断虚弱。在英国和爱尔兰妇产科课程中，对虚弱手术患者管理的正规教育存在未满足的需求。
