Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
J Surg Res. 2021 Jun;262:175-180. doi: 10.1016/j.jss.2020.11.055. Epub 2021 Feb 12.
The impact of general surgery resident participation on operative case time and postoperative complications has been broadly studied in the United States. Although surgical trainee involvement in international humanitarian surgical care is escalating, there is limited information as to how this participation affects care rendered. This study examines the impact of trainee involvement on case length and immediate postoperative complications with regard to operations in low- and middle-income settings.
A retrospective chart review was conducted of humanitarian surgeries completed during annual short-term surgical missions performed by the International Surgical Health Initiative to Ghana and Peru. Between 2017 and 2019, procedures included inguinal hernia repairs and total abdominal hysterectomies (TAHs). Operative records were reviewed for case type, duration, and immediate postoperative complications. Cases were categorized as involving two attending co-surgeons (AA) or one attending and resident assistant (RA).
There were 135 operative cases between 2017 and 2019; the majority (82%) involved a resident assistant. There were no statistically significant differences in case times between the attending assistant (AA) and resident assistant (RA) cohorts in both case types. All 23 postoperative complications were classified as Clavien-Dindo Grade I. In addition, resident assistance did not lead to a statistically significant increase in complication rate; 26% in the AA cohort versus 74% in the RA cohort (P = 0.3).
This pilot study examining 135 operative cases over 2 y of humanitarian surgeries demonstrates that there were no differences in operative duration or complication rates between the AA and RA cohorts. We propose that surgical trainee involvement in low- and middle-income settings do not adversely impact operative case times or postoperative complications.
在美国，广泛研究了普通外科住院医师参与对手术时间和术后并发症的影响。尽管外科培训生参与国际人道主义外科护理的人数不断增加，但关于这种参与如何影响所提供的护理的信息有限。本研究检查了培训生参与对中低收入环境中手术的手术时间和术后即刻并发症的影响。
对国际外科卫生倡议在加纳和秘鲁进行的年度短期外科任务中完成的人道主义手术进行了回顾性图表审查。在 2017 年至 2019 年期间，手术包括腹股沟疝修补术和全子宫切除术（TAH）。审查手术记录以了解手术类型、持续时间和术后即刻并发症。病例分为两名主治外科医生共同参与（AA）或一名主治医生和住院医生助理（RA）。
在 2017 年至 2019 年期间，有 135 例手术；大多数（82%）涉及住院医生助理。在两种手术类型中，主治外科医生助理（AA）和住院医生助理（RA）组的手术时间均无统计学差异。所有 23 例术后并发症均被归类为 Clavien-Dindo 分级 I。此外，住院医生助理并没有导致并发症发生率的统计学显著增加；AA 组为 26%，RA 组为 74%（P=0.3）。
本研究对 2 年人道主义手术中的 135 例手术进行了试点研究，结果表明 AA 和 RA 组之间手术持续时间或并发症发生率没有差异。我们提出，在中低收入国家，外科培训生的参与不会对手术时间或术后并发症产生不利影响。
