Basques Bryce A, Saltzman Bryan M, Korber Shane S, Bolia Ioanna K, Mayer Erik N, Bach Bernard R, Verma Nikhil N, Cole Brian J, Weber Alexander E
Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.
Orthop J Sports Med. 2020 Dec 16;8(12):2325967120967460. doi: 10.1177/2325967120967460. eCollection 2020 Dec.
Whether resident involvement in surgical procedures affects intra- and/or postoperative outcomes is controversial.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare operative time, adverse events, and readmission rate for arthroscopic knee surgery cases with and without resident involvement. We hypothesized that resident involvement would not negatively affect these variables.
Cohort study; Level of evidence, 3.
A retrospective review of the prospectively maintained National Surgical Quality Improvement Program was performed. Patients who underwent arthroscopic knee surgery between 2005 and 2012 were identified. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts. Because of multiple statistical comparisons, a Bonferroni correction was used, and statistical significance was set at < .004.
A total of 29,539 patients who underwent arthroscopic knee surgery were included in the study, and 11.3% of these patients had a resident involved with the case. The overall rate of adverse events was 1.62%. On multivariate analysis, resident involvement was not associated with increased rates of adverse events or readmission. Resident cases had a mean 6-minute increase in operative time ( < .001).
Overall, resident involvement in arthroscopic knee surgery was not associated with an increased risk of adverse events or readmission. Resident involvement was associated with only a mean increased operative time of 6 minutes, a difference that is not likely to be clinically significant. These results support the safety of resident involvement with arthroscopic knee surgery.
住院医师参与手术操作是否会影响术中及/或术后结果存在争议。
目的/假设：本研究的目的是比较有住院医师参与和无住院医师参与的关节镜膝关节手术病例的手术时间、不良事件及再入院率。我们假设住院医师的参与不会对这些变量产生负面影响。
队列研究；证据等级，3级。
对前瞻性维护的国家外科质量改进计划进行回顾性分析。确定2005年至2012年间接受关节镜膝关节手术的患者。采用具有稳健误差方差的多变量泊松回归比较有住院医师参与和无住院医师参与的病例术后30天内不良事件和再入院率。采用多变量线性回归比较两组队列的手术时间。由于进行了多次统计比较，使用了Bonferroni校正，设定统计学显著性为P<0.004。
本研究共纳入29539例接受关节镜膝关节手术的患者，其中11.3%的患者有住院医师参与手术。不良事件总发生率为1.62%。多变量分析显示，住院医师参与手术与不良事件或再入院率增加无关。有住院医师参与的病例手术时间平均增加6分钟（P<0.001）。
总体而言，住院医师参与关节镜膝关节手术与不良事件或再入院风险增加无关。住院医师参与手术仅使手术时间平均增加6分钟，这一差异可能无临床意义。这些结果支持住院医师参与关节镜膝关节手术的安全性。
