Department of Surgery, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Drive, Collamore 501, Boston, MA, 02118, USA.
Surg Endosc. 2022 Feb;36(2):1554-1562. doi: 10.1007/s00464-021-08444-8. Epub 2021 Mar 24.
As fellowship training after general surgery residency has become increasingly common, the impact on resident education must be considered. Patient safety and procedure outcomes are often used as justification by attendings who favor fellows over residents in certain minimally invasive surgery (MIS) operations. The aim of the present study was to compare the impact of trainee level on the outcomes of selected MIS operations to determine if giving preference to fellows on grounds of outcomes is warranted.
Patients who underwent elective laparoscopic hiatal hernia repair (LHHR), laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic splenectomy (LS), laparoscopic cholecystectomy (LC), or laparoscopic ventral hernia repair (LVHR) with assistance of a general surgery chief resident or fellow were identified from the American College of Surgeon's National Surgical Quality Improvement Program database (2007-2012). Patients were matched 1:1 based on propensity score for the odds of undergoing operations assisted by a fellow.
5145 patients underwent LHHR, 1396 LSG, 9656 LRYGB, 863 LS, 13,434 LC, and 3069 LVHR. Fellows assisted in 41.7% of LHHR, 49.2% of LSG, 56.4% of LRYGB, 25.7% of LS, 17.1% of LC, and 27.0% of LVHR cases. After matching, overall and severe complication rates were comparable between cases performed with assistance of a fellow or chief resident. Median operative time was longer for LSG, LRYGB, and LC when a fellow assisted.
Surgical outcomes were similar between fellow and chief resident assistance in MIS operations, arguing that increased resident participation in basic and complex laparoscopic operations is appropriate without compromising patient safety.
随着普通外科住院医师培训后接受专科培训变得越来越普遍，必须考虑其对住院医师教育的影响。在某些微创手术（MIS）操作中，主治医师更倾向于选择住院医师而非专科医师，他们通常会使用患者安全和手术结果作为理由。本研究旨在比较受训者水平对选定 MIS 手术结果的影响，以确定是否有理由根据结果优先考虑住院医师。
从美国外科医师学院国家手术质量改进计划数据库（2007-2012 年）中确定了接受普通外科住院医师或专科医师协助的腹腔镜食管裂孔疝修补术（LHHR）、腹腔镜袖状胃切除术（LSG）、腹腔镜 Roux-en-Y 胃旁路术（LRYGB）、腹腔镜脾切除术（LS）、腹腔镜胆囊切除术（LC）或腹腔镜腹疝修补术（LVHR）的患者。根据接受专科医师协助手术的可能性，使用倾向评分对患者进行 1:1 匹配。
5145 例患者接受 LHHR 手术，1396 例 LSG 手术，9656 例 LRYGB 手术，863 例 LS 手术，13434 例 LC 手术，3069 例 LVHR 手术。在 LHHR 手术中，41.7%由专科医师协助，在 LSG 手术中，49.2%由专科医师协助，在 LRYGB 手术中，56.4%由专科医师协助，在 LS 手术中，25.7%由专科医师协助，在 LC 手术中，17.1%由专科医师协助，在 LVHR 手术中，27.0%由专科医师协助。匹配后，由专科医师或住院医师协助的病例的总体和严重并发症发生率相似。LSG、LRYGB 和 LC 手术时，专科医师协助的手术时间中位数较长。
在 MIS 手术中，专科医师和住院医师的协助下手术结果相似，这表明增加住院医师参与基本和复杂腹腔镜手术是合适的，不会影响患者安全。
